Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma

Abstract

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.

Male Gender Is Associated with Lymph Node Metastasis but Not with Recurrence in Papillary Thyroid Carcinoma

“…Consistent with those studies, we confirmed that LNM was associated with poor prognosis. Male gender is generally thought to be closely related to recurrence of PTC [9,11,33,34]. Ito et al reported that male gender is a risk factor for lymph node recurrence [35].…”

Ferroptosis-related gene signature predicts the prognosis of papillary thyroid carcinoma

“…Thyroid cancer is the most common endocrine malignancy with a rapidly increasing incidence worldwide [ 27 ]. Although the majority of PTC patients have an excellent prognosis, there are also some patients with recurrence, distant metastasis and even other worse ending, affecting the survival time of patients [ 28 , 29 ]. Therefore, it is particularly important to carry out risk stratification management to optimize the therapy for PTC patients.…”

Microscopic Extrathyroidal Extension Results in Increased Rate of Tumor Recurrence and Is an Independent Predictor of Patient’s Outcome in Middle Eastern Papillary Thyroid Carcinoma

“…Papillary thyroid cancer (PTC) is the most common thyroid malignancy and generally carries favorable prognosis (3)(4)(5), whereby low risk PTC patients have excellent outcome with conservative treatment, such as adequate surgery and TSH suppressive therapy (6,7). However, a subset of PTC patients present with aggressive disease and experience recurrence, leading to poor prognosis (8)(9)(10). Therefore, identifying tumors with potentially aggressive behavior and increased likelihood of recurrence is crucial for therapeutic decision-making and appropriate patient management.…”