A Proposed Grading Scheme for Medullary Thyroid Carcinoma Based on Proliferative Activity (Ki-67 and Mitotic Count) and Coagulative Necrosis.
A Proposed Grading Scheme for Medullary Thyroid Carcinoma Based on Proliferative Activity (Ki-67 and Mitotic Count) and Coagulative Necrosis.
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DOI：
10.1097/pas.0000000000001505
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发表时间：
2020-10
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影响因子：
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通讯作者：
Gill AJ
中科院分区：
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作者：
Fuchs TL;Nassour AJ;Glover A;Sywak MS;Sidhu SB;Delbridge LW;Clifton-Bligh RJ;Gild ML;Tsang V;Robinson BG;Clarkson A;Sheen A;Sioson L;Chou A;Gill AJ
我们研究了一系列组织学参数对甲状腺髓样癌（MTC）的预后价值，以设计一个预测总生存率的分级系统。我们评估了76例接受原发性肿瘤切除术的MTC患者的年龄、性别、肿瘤大小、血管间隙浸润、淋巴结转移、多发性内分泌瘤2型（MEN 2）状态、有丝分裂计数、Ki-67增殖指数、梭形形态、片状生长模式、凝固性坏死、早期坏死、核分级、多核、核仁突出、纤维化和淀粉样蛋白沉积。除了年龄和MEN 2诊断的临床特征外，显著预测总生存率降低的唯一组织学特征是Ki-67增殖指数、有丝分裂计数和凝固性坏死的存在。使用这3个变量的组合，我们提出了一个3层分级系统的基础上增殖活性（Ki-67增殖指数和有丝分裂计数）和坏死。有62例（82%）低度MTC（低增殖活性，无坏死），9例（12%）中度MTC（低增殖活性和坏死，或中度增殖活性和无坏死），5例（7%）高度MTC（中度增殖活性和坏死，或高增殖活性伴或不伴坏死）。3个等级的平均总生存期分别为193、146和45个月（P=0.0001）。当控制与生存相关的其他因素（包括年龄和已知的MEN 2综合征）时，分级系统仍具有预后性。我们的结论是，这个建议的分级系统，它只使用增殖活性（Ki-67指数，有丝分裂计数）和凝固性坏死的组合，是一个强有力的预测MTC的总生存率。
We investigated the prognostic value of a range of histologic parameters in medullary thyroid carcinoma (MTC) to design a grading system to predict overall survival. We assessed 76 patients with MTCs undergoing primary tumor resection for age, sex, tumor size, vascular space invasion, lymph node metastasis, multiple endocrine neoplasia type 2 (MEN2) status, mitotic count, Ki-67 proliferative index, spindled morphology, sheet-like growth pattern, coagulative necrosis, incipient necrosis, nuclear grade, multinucleation, prominent nucleoli, fibrosis, and amyloid deposition. In addition to the clinical features of age and the diagnosis of MEN2, the only histologic features that significantly predicted reduced overall survival were Ki-67 proliferative index, mitotic count, and the presence of coagulative necrosis. Using a combination of these 3 variables, we propose a 3-tiered grading system based solely on proliferative activity (Ki-67 proliferative index and mitotic count) and necrosis. There were 62 (82%) low-grade MTCs (low proliferative activity, no necrosis), 9 (12%) intermediate grade (low proliferative activity and necrosis present, or intermediate proliferative activity and no necrosis), and 5 (7%) high grade (intermediate proliferative activity and necrosis present, or high proliferative activity with or without necrosis). The mean overall survival was 193, 146, and 45 months, respectively (P=0.0001) for the 3 grades. The grading system remained prognostic when controlled for other factors associated with survival including age and known MEN2 syndrome. We conclude that this proposed grading system, which uses only a combination of proliferative activity (Ki-67 index, mitotic count) and coagulative necrosis, is a strong predictor of overall survival in MTC.