Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma
1
Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal
2
IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal
3
Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
4
Department of Pathology, Parc Taulí Sabadell Hospital Universitari-Institut d’Investigació i Innovació Parc Taulí-I3PT-Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
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Department of Endocrinology, Centro Hospitalar Universitário de Coimbra, 3004-561 Coimbra, Portugal
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Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal
7
Department of Pathology, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
8
Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
9
Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
*
Authors to whom correspondence should be addressed.
Cancers 2020, 12(11), 3186; https://doi.org/10.3390/cancers12113186
Received: 30 September 2020
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Revised: 14 October 2020
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Accepted: 20 October 2020
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Published: 29 October 2020
(This article belongs to the Special Issue Follicular Cell-Derived Thyroid Carcinomas: Current Status and Future Prospects)
Simple Summary
Thyroid cancer incidence is increasing, with overdiagnosis being the major driver of the thyroid cancer “epidemic”. Papillary thyroid carcinoma, usually with excellent prognosis, sometimes has an aggressive metastatic pattern. This heterogeneity in progression makes it difficult to tailor treatment strategies for an individual patient. We aimed to identify clinicopathological factors associated with papillary thyroid carcinoma recurrence, persistence, and specific mortality. Our study supports that both pre-surgical factors, such as male gender, presence of psammoma bodies, gross extra-thyroidal extension, and lateral compartment lymph node metastases, as well as lymph vessel invasion, venous invasion, presence of necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of PTC patients. The same is true when analysis is restricted to stage I patients. The importance of this report is to emphasize clinical and imaging pre-surgical thyroid cancer patients’ evaluation for an appropriate surgical treatment and patient prognosis.
Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
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Keywords:
thyroid cancer; prognosis; clinicopatholigical; outcomes
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MDPI and ACS Style
Póvoa, A.A.; Teixeira, E.; Bella-Cueto, M.R.; Melo, M.; Oliveira, M.J.; Sobrinho-Simões, M.; Maciel, J.; Soares, P. Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma. Cancers 2020, 12, 3186. https://doi.org/10.3390/cancers12113186
AMA Style
Póvoa AA, Teixeira E, Bella-Cueto MR, Melo M, Oliveira MJ, Sobrinho-Simões M, Maciel J, Soares P. Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma. Cancers. 2020; 12(11):3186. https://doi.org/10.3390/cancers12113186
Chicago/Turabian StylePóvoa, Antónia A., Elisabete Teixeira, Maria R. Bella-Cueto, Miguel Melo, Maria J. Oliveira, Manuel Sobrinho-Simões, Jorge Maciel, and Paula Soares. 2020. "Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma" Cancers 12, no. 11: 3186. https://doi.org/10.3390/cancers12113186
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