Prognostic Factors in Well‐Differentiated Thyroid Carcinoma

Cushing, Sharon L.; Palme, Carsten E.; Audet, Nathalie; Eski, Spiro; Walfish, Paul G.; Freeman, Jeremy L.

doi:10.1097/01.mlg.0000149442.22393.e2

Cited by 66 publications

(57 citation statements)

References 12 publications

(24 reference statements)

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“…have an outcome (5-yr OS of 60%) that was intermediate between that of the overall indolent, welldifferentiated papillary and follicular carcinomas (98% OS at 10 years) 13 and the highly lethal anaplastic carcinoma (0% OS at 5 years). 8 PDTC defined mainly on the basis of growth pattern (such as the tumors reported in the large Italian study by Volante et al 8 ) also occupy an intermediate position at the prognostic level on the spectrum of thyroid carcinoma progression.…”

Section: Discussionmentioning

confidence: 97%

Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis

Hiltzik¹,

Carlson²,

Tuttle³

et al. 2006

Cancer

287

216

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BACKGROUNDPoorly differentiated thyroid carcinomas (PDTC) occupy an intermediate position at the prognostic level on the spectrum of thyroid carcinoma progression. However, their histologic definition is controversial. The objective of the current study was to assess the prognostic significance of PDTC defined on the basis of mitosis and necrosis and search for prognostic markers within this group of tumors that are predictive of overall survival (OS) and progression‐free survival (PFS).METHODSPDTC was defined as thyroid carcinoma with follicular cell differentiation at the histologic and/or immunohistochemical levels and displaying tumor necrosis and/or ≥ 5 mitoses per 10 high‐power fields (×400). Retrospective chart review and microscopic examination identified 58 patients with primary tumors meeting the above criteria and seen at the Memorial Sloan‐Kettering Cancer Center between 1992 and 2004. These 58 patients were analyzed for various histologic, clinical, and imaging parameters. Each parameter was correlated with OS and PFS.RESULTSOf the 58 patients studied, 22 (38%) patients died of disease with a 5‐year OS rate of 60%. Forty‐three of the 58 patients (74%) developed disease recurrence or disease progression, with a 5‐year PFS rate of 25%. The median follow‐up for the entire patient population was 42.6 months (range, 4–205 mos). A tumor size > 4 cm was found to be correlated with a decreased PFS time (P < 0.001). Those tumors with a capsule demonstrated a significantly improved OS compared with unencapsulated tumors (P = 0.001). The extent of capsular invasion was found to be a significant adverse factor for PFS (P = 0.05). The presence of extrathyroid extension into perithyroid soft tissue was found to be correlated with a decreased OS (P = 0.001) and PFS (P = 0.004). Of 27 patients with distant metastasis, 19 (70%) had concentrated radioactive iodine (RAI) at their metastatic sites. On multivariate analysis, extrathyroid extension and tumor size emerged as the only significant variables in predicting PFS (P = 0.04 and P = 0.01, respectively) whereas extrathyroid extension was found to be the sole independent prognostic factor for OS (P = 0.01). Growth pattern and cell type did not appear to influence outcome.CONCLUSIONSPDTC defined on the basis of mitosis and necrosis constitutes a group of tumors that is more aggressive and homogeneous than PDTC defined by growth pattern. Within this group of patients, microstaging (tumor size, the extent of capsular invasion, and, especially, extrathyroid extension), and not growth pattern or cell type, is able to stratify patients into different prognostic categories. RAI uptake occurs in a significant number of patients with PDTC. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 97%

Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis

Hiltzik¹,

Carlson²,

Tuttle³

et al. 2006

Cancer

287

216

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“…ETE is defined as extension of the primary tumor outside of the thyroid capsule with invasion into the surrounding structures (35). Gross ETE has been identified as carrying a higher risk for local recurrence (36,37) and is used in several staging systems, including TNM (tumor, node, and metastasis) (38), AGES (age, grade, ETE, and size) (39), AMES (age, metastasis, ETE, and size) (40), and MACIS (metastasis, age, completeness of resection, invasion, and size) (41). Since an active surveillance management approach or an initial surgery less than a total thyroidectomy are best reserved for patients with intrathyroidal PTC, the ability to predict the presence of ETE using diffusion weighted MRI will allow the clinician to identify patients that are likely to benefit from more aggressive initial therapy and therefore have a significant impact on clinical management, particularly in low risk thyroid cancers.…”

Section: Discussionmentioning

confidence: 99%

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

Moreira

Hatzoglou

et al. 2015

Thyroid

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Background: Initial management recommendations of papillary thyroid carcinoma (PTC) are very dependent on preoperative studies designed to evaluate the presence of PTC with aggressive features. The purpose of this study was to evaluate whether diffusion-weighted magnetic resonance imaging (DW-MRI) before surgery can be used as a tool to stratify tumor aggressiveness in patients with PTC. Methods: In this prospective study, 28 patients with PTC underwent DW-MRI studies on a three Tesla MR scanner prior to thyroidectomy. Due to image quality, 21 patients were finally suitable for further analysis. Apparent diffusion coefficients (ADCs) of normal thyroid tissues and PTCs for 21 patients were calculated. Tumor aggressiveness was defined by surgical histopathology. The Mann-Whitney U test was used to compare the difference in ADCs among groups of normal thyroid tissues and PTCs with and without features of tumor aggressiveness. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative specificity, sensitivity, and accuracy of and determine the cutoff value for the ADC in stratifying PTCs with tumor aggressiveness. Results: There was no significant difference in ADC values between normal thyroid tissues and PTCs. However, ADC values of PTCs with extrathyroidal extension (ETE; 1.53 -0.25 · 10 -3 mm 2 /s) were significantly lower than corresponding values from PTCs without ETE (2.37 -0.67 · 10 -3 mm 2 /s; p < 0.005). ADC values identified 3 papillary carcinoma patients with extrathyroidal extension that would have otherwise been candidates for observation based on ultrasound evaluations. The cutoff value of ADC to discriminate PTCs with and without ETE was determined at 1.85 · 10 -3 mm 2 /s with a sensitivity of 85%, specificity of 85%, and ROC curve area of 0.85. Conclusion: ADC value derived from DW-MRI before surgery has the potential to stratify ETE in patients with PTCs.

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“…However, a number of studies have reported a mortality rate of ≤10% (5,18). This difference may be attributable to variability in the use of treatment approaches and classification systems between studies.…”

Section: Discussionmentioning

confidence: 99%

“…WDTC neoplasms may arise from follicular cells [papillary (PTC), follicular (FTC) or Hürthle cell (HTC) carcinomas] or from parafollicular cells (medullary thyroid carcinoma) (3,4). Although WDTC accounts for <1% of all cancers, it results in >70% of mortalities from thyroid carcinomas (5).…”

Section: Introductionmentioning

confidence: 99%

Association between prognostic factors and clinical outcome of well-differentiated thyroid carcinoma: A retrospective 10-year follow-up study

Lei

Ding

et al. 2015

Oncology Letters

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Abstract. Differentiated thyroid carcinoma (DTC) is one of the most common metabolic disorders and accounts for 98% of all cases of thyroid cancer. Previously, a number of studies have investigated the prognostic factors associated with well-differentiated thyroid carcinoma (WDTC); however, these studies yielded conflicting results. The current study used a retrospective study design to collect data from WDTC patients who had received the same treatment regimen from the same institute, with a minimum follow-up of 10 years. The De Groot staging system was used to classify WDTC in a total of 320 patients (240 females and 80 males). Among the subjects, the pathological subtypes identified were as follows: Papillary carcinoma (240 cases, 75%), follicular carcinoma (67 cases, 21%) and Hürthle cell carcinoma (13 cases, 4%). Prognostic factors that significantly affected the clinical outcome of the disease were advanced age (P=0.001), tumor size (P=0.03), presence of thyroglobulin (P=0.001) and De Groot stage (P=0.005). The 10-year follow-up study revealed that WDTC is associated with a high survival rate of 96% (307/320 patients survived) and a low mortality rate (4%).

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Prognostic Factors in Well‐Differentiated Thyroid Carcinoma

Cited by 66 publications

References 12 publications

Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis

Poorly differentiated thyroid carcinomas defined on the basis of mitosis and necrosis

Using Diffusion-Weighted MRI to Predict Aggressive Histological Features in Papillary Thyroid Carcinoma: A Novel Tool for Pre-Operative Risk Stratification in Thyroid Cancer

Association between prognostic factors and clinical outcome of well-differentiated thyroid carcinoma: A retrospective 10-year follow-up study

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