Risk Stratification of Follicular Variant of Papillary Thyroid Carcinoma
Risk Stratification of Follicular Variant of Papillary Thyroid Carcinoma
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DOI：
10.1089/thy.2012.0369
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发表时间：
2013-03-01
期刊：
影响因子：
6.6
通讯作者：
Barletta, Justine A.
中科院分区：
文献类型：
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作者：
Vivero, Marina;Kraft, Stefan;Barletta, Justine A.
背景：最近的研究描述了一种包膜型和浸润型的滤泡型甲状腺乳头状癌（FVPTC）。虽然据报道，如果没有血管侵袭和包膜穿透，包膜肿瘤几乎没有转移潜力或复发风险，但浸润性肿瘤已被发现具有显著的转移潜力和复发风险。在我们的经验中，大量FVPTC既不是完全包裹的也不是浸润性的，而是部分包裹的（PE）或良好限制的（WC）。因此，本研究的目的是调查的转移潜力和复发风险的PE/WC FVPTCs相比，封装和infiltrative tumor.Methods：我们研究了77 FVPTCs切除之间的2000年和2002年，其特点是封装，PE/WC，或浸润性肿瘤。组织学评估，然后与淋巴结状态和临床outcome.Results：在我们的队列，27（35%）肿瘤被包裹，35（45%）PE/WC，和15（19%）浸润。PE/WC和包膜肿瘤之间的淋巴结状态相似，但包膜组和浸润组之间（p < 0.001）以及PE/WC和浸润组之间（p < 0.001）存在显著差异。所有15例包裹性肿瘤和所有9例PE/WC肿瘤均无淋巴结转移，但9例浸润性肿瘤中有7例（78%）存在淋巴结转移。对于可获得临床随访的患者（66例，86%），中位随访时间为111个月。无包裹性肿瘤患者复发，1例（3%）PE/WC肿瘤患者复发/残留疾病，2例（15%）浸润性肿瘤患者复发/残留疾病。1例PE/WC肿瘤患者在初次切除后7年复发/残留疾病，瘤床复发。值得注意的是，这是唯一的病人在PE/WC组有一个积极的切除margin.Conclusions：我们的研究结果表明，PE/WC FVPTC有一个非常低的转移潜力/复发的风险，这表明他们应该区别于更具侵略性的浸润性FVPTC。
Background: Recent studies have described an encapsulated and an infiltrative form of follicular variant of papillary thyroid carcinoma (FVPTC). While encapsulated tumors have been reported to have virtually no metastatic potential or recurrence risk if angioinvasion and capsular penetration are absent, infiltrative tumors have been found to have a significant metastatic potential and a risk of recurrence. In our experience, a substantial number of FVPTCs are neither fully encapsulated nor infiltrative, but instead are partially-encapsulated (PE) or well-circumscribed (WC). Thus, the aim of this study was to investigate the metastatic potential and recurrence risk of PE/WC FVPTCs in comparison with that of encapsulated and infiltrative tumors.Methods: We studied 77 FVPTCs resected between 2000 and 2002 and characterized the tumors as encapsulated, PE/WC, or infiltrative. Histologic assessment was then correlated with lymph node status and clinical outcome.Results: In our cohort, 27 (35%) tumors were encapsulated, 35 (45%) were PE/WC, and 15 (19%) were infiltrative. Lymph node status was similar between PE/WC and encapsulated tumors, but was significantly different between encapsulated and infiltrative groups (p < 0.001), and PE/WC and infiltrative groups (p < 0.001). Lymph node metastases were absent in all 15 cases of encapsulated tumors and all 9 cases of PE/WC tumors with sampled lymph nodes, but were present in 7 of 9 (78%) cases of infiltrative tumors with sampled lymph nodes. For patients with available clinical follow-up (66 cases, 86%), the median follow-up time was 111 months. No patients with encapsulated tumors recurred, one (3%) patient with a PE/WC tumor had recurrent/residual disease, and two (15%) patients with infiltrative tumors had recurrent/residual disease. The one patient with a PE/WC tumor who had recurrent/residual disease had a tumor bed recurrence 7 years after initial resection. Significantly, this was the only patient in the PE/WC group that had a positive resection margin.Conclusions: Our results demonstrate that PE/WC FVPTCs have a very low metastatic potential/recurrence risk, indicating that they should be distinguished from more aggressive infiltrative FVPTCs.