Extranodal Extension of Metastatic Papillary Thyroid Carcinoma: Correlation with Biochemical Endpoints, Nodal Persistence, and Systemic Disease Progression
Extranodal Extension of Metastatic Papillary Thyroid Carcinoma: Correlation with Biochemical Endpoints, Nodal Persistence, and Systemic Disease Progression
复制标题
DOI：
10.1089/thy.2013.0027
复制
发表时间：
2013-09-01
期刊：
影响因子：
6.6
通讯作者：
Ridge, John A.
中科院分区：
文献类型：
--
作者：
Lango, Miriam;Flieder, Douglas;Ridge, John A.
背景：转移性甲状腺乳头状癌(PTC)的结外转移(ENE)对近期和长期临床结果(包括生化检测)的影响尚未见报道。方法：这项由美国国家癌症研究所指定的综合癌症中心的单一机构队列研究包括肉眼转移的患者，排除了术后大体残留病变、远处病变或低分化乳头状癌的患者。在最初给药前抑制或刺激甲状腺球蛋白(TG)50 ng/ml，预示结节疾病的进展，也预测全身疾病的最终发展(p=0.0001)。在stg>；50 ng/ml的患者中，超过70%的患者在5年内接受了结节持续性手术。ENE的存在降低了发生生化CR的几率(优势比3.5%[可信区间1.3-10]，p=0.02)，增加了术后STG水平超过50 ng/mL的概率(优势比5[可信区间1.2-21]，p=0.03)。结论：ENE降低了区域转移性PTC治疗后发生生化性CR的可能性，增加了初次切除后肿瘤残留的可能性，可能是由于大量转移。ENE和结节持续时间独立预测最终的系统性疾病进展。
Background: The impact of extranodal extension (ENE) of metastatic papillary thyroid carcinoma (PTC) on short- and long-term clinical outcomes, including biochemical testing, has not been reported.Methods: This single-institution National Cancer Institute-designated Comprehensive Cancer Center cohort study included patients with macroscopic metastases and excluded patients with gross residual disease after surgery, distant disease, or poorly differentiated papillary carcinoma. A suppressed or stimulated thyroglobulin (Tg) 50 ng/mL prior to initial RAI administration, heralded the progression of nodal disease, and also predicted the eventual development of systemic disease (p=0.0001). Of those with a sTg >50 ng/mL, over 70% underwent surgery for nodal persistence within five years. The presence of ENE diminished the odds of a biochemical CR (odds ratio 3.5% [CI 1.3-10], p=0.02), and increased the probability that the sTg levels after surgery will exceed 50 ng/mL (odds ratio 5 [CI 1.2-21], p=0.03). Following surgery for tumor persistence, 25% of those with ENE were rendered biochemically free of disease.Conclusions: ENE diminishes the probability of a biochemical CR after treatment for regional metastatic PTC, and increases the probability of tumor persistence after initial resection, likely from abundant metastasis. ENE and nodal persistence independently predict eventual systemic disease progression.