Prognostic Outcomes of Tall Cell Variant Papillary Thyroid Cancer: A Meta-Analysis

Abstract

Objective. To evaluate the prognosis of tall cell variant (TCV) compared to usual variant (UV) papillary thyroid cancer by comparing disease-related mortality and recurrence data from published studies. Methods. Ovid MEDLINE keyword search using “tall cell variant papillary thyroid cancer” was used to identify studies published in English that calculated disease-related mortality and recurrence rates for both TCV and UV. Results. A total of 131 cases of tall cell variant papillary thyroid cancer were reviewed. The combined odds ratio of recurrence for TCV compared to UV is 4.50 with a 95% confidence interval from 2.90 to 6.99. For disease-related mortality, the combined odds ratio for TCV was compared to UV of 14.28 with a 95% confidence interval from 8.01 to 25.46. Conclusion. Currently published data suggests that TCV is a negative prognostic indicator in papillary thyroid cancer and requires aggressive therapy. This meta-analysis provides the largest prognostic data series on TCV in the literature and clearly identifies the need for accurate pathological identification of TCV and its further study as an independent prognostic factor.

Higher Incidence of Tall Cell Variant of Papillary Thyroid Carcinoma in Graves' Disease

“…Recent studies have suggested that the TCV should be treated with more aggressive approach. This includes total thyroidectomy followed by central compartment neck dissection and radioactive iodine ablation, regardless of tumor size (27,34). The unfavorable effect of TCV PTC on prognosis may necessitate a cautious and more aggressive approach than the one that is followed in the majority of patients with pure PTC.…”

Can the Tall Cell Variant of Papillary Thyroid Carcinoma Be Distinguished from the Conventional Type in Fine Needle Aspirates? A Cytomorphologic Study with Assessment of Diagnostic Accuracy

“…In a recent meta-analysis, Jalisi et al [36] reviewed a total of 131 cases of TCV and found that compared to cPTC, the combined odds ratio of recurrence and disease-related mortality for TCV is 4.5 and 14.28, respectively. As such, clinical guidelines suggest that TCV requires more aggressive clinical management [7].…”

“…Compared to conventional PTC (cPTC), TCV-PTCs tend to present in women and at an older age. They also have a higher rate of extrathyroidal extension and a poorer 5-year disease-specific survival than cPTC [4,5,6]. Therefore, if TCV-PTC features can be recognized in preoperative fine needle aspiration (FNA), the surgeon could be alerted to the presence of a potentially aggressive tumor so that the type and/or extent of initial surgery can be modified [7].…”

Aggressive variants of follicular cell derived thyroid carcinoma; the so called ‘Real Thyroid Carcinomas’

“…However, recent data support that tall-cell histology alone remains a significant prognostic factor independent of age, gender, and tumour size and ETE 14. A meta-analysis of 131 cases of TCV-PTC showed 4.5 times recurrence rate and 14 times greater disease-related mortality as compared with classical PTC 18. It has been suggested that the aggressive behaviour of TCV-PTC is associated with the molecular profile of these tumours 19.…”