Prognostic importance of histologic vascular invasion in papillary thyroid carcinoma

OBJECTIVE: To conduct a retrospective study of 39 patients with papillary carcinoma of the thyroid with histologic vascular invasion (VI+) and 361 patients without any sign of vascular invasion (VI-). SUMMARY BACKGROUND DATA: In the present study, we undertook a retrospective analysis of papillary carcinoma of the thyroid to assess whether histologically determined vascular invasion can be considered a predictive factor for prognosis. METHODS: By means of a retrospective study, we evaluated the department's database of patients with papillary thyroid carcinoma who had undergone total thyroidectomy from January 1993 to December 1999. RESULTS: Group I consisted of papillary carcinoma without any sign of vascular invasion (VI-) comprising 361 patients. Group II consisted of papillary carcinoma with vascular invasion (VI+) comprising 39 patients. At the time of diagnosis, we observed no metastases in patients with VI-, whereas a pulmonary metastasis was observed in 1 patient with VI+ (P = 0.0023). In 3.6% patients with VI- and in 20.5% patients with VI+, we observed recurrences in the regional lymph nodes (P < 0.001); we observed 6 (1.66%) distant metastases in patients with VI- and in the 12.8% patients with VI+ (P < 0.001). Three patients with VI+ (7.7%) and 2 patients with VI- (0.6%) died of tumor-related causes; these figures were found to be statistically significant (P < 0.001). CONCLUSIONS: In papillary carcinoma, it should be noted that histologic vascular invasion may be considered as a sign of an increased tendency toward hematogenic invasion and consequent increase in the relative percentage of metastases; ultimately, this means a poorer prognosis. In the presence of risk factors indicating a possible increase in biologic aggressiveness, adequate postoperative treatment and close follow up become essential.     

The clinicopathological significance of histologic vascular invasion in differentiated thyroid carcinoma

BACKGROUND: Clinicopathological correlation and clinical importance of histologic vascular invasion in differentiated thyroid carcinoma have not been fully examined. METHODS: Histologic vascular invasion of 256 differentiated thyroid carcinomas was examined using Victoria-blue hematoxylin-eosin staining. RESULTS: Vascular invasion was found in 120 patients and was independently related to lymph node metastasis (P <0.0001), extrathyroidal invasion (P = 0.0003) and differentiation (P = 0.0183). Patients with vascular invasion more frequently relapsed than those without (P = 0.0069). The disease-free survival of patients with vascular invasion (15.6 +/- 1.8 years) was shorter than that of patients without vascular invasion (20.5 +/- 0.9 years, P = 0.0001). In multivariate analysis, vascular invasion is an independent prognostic factor for disease-free survival, but not for overall survival. CONCLUSIONS : These data suggest that histologic vascular invasion is associated with clinicopathologically aggressive thyroid carcinomas with lymphatic and hematogenous spread and is a prognostic factor for disease-free survival.     

Do the prognoses of papillary and follicular thyroid carcinomas differ?

Our 44 patients with follicular thyroid carcinoma had a survival rate similar to patients of the same age and sex with papillary carcinoma. By matching our patients by age and sex, this study appears to show that the biologic behavior of differentiated thyroid carcinomas is better correlated with the age and sex of the patients than with the pathologic classification of papillary carcinoma or follicular carcinoma; therefore, it is unnecessary to distinguish between patients with papillary carcinoma and follicular carcinoma from a prognostic standpoint. A classification considering all well-differentiated thyroid carcinomas as one disease with behavioral variability due to constitutional factors such as age and sex should be adopted.     

CK19、CD56与PCNA在甲状腺乳头状癌与乳头状增生中的表达及意义

目的探讨CK19、CD56与PCNA在甲状腺乳头状癌(PTC)与甲状腺乳头状增生(BPH)中的表达及意义。方法回顾性分析自2009年10月至2011年1月收治的46例PTC及42例BPH患者,应用免疫组织化学En Vision法测定CK19、CD56与PCNA表达情况,及其在PTC及BPH中的灵敏率及特异度。使用SPSS 15.0软件进行统计分析,CK19、CD56与PCNA在PTC、BPH中的表达率采用χ2检验,以P0.05为差异有统计学意义。结果 CK19在PTC、BPH中的表达阳性率分别为93.5%(高表达)及31.0%(低表达)χ2=37.08,P0.005;CD56在PTC、BPH中的表达阳性率分别为15.2%(低表达)及66.7%(高表达)χ2=23.03,P0.005;PCNA在PTC、BPH中的表达阳性率分别为63.0%(高表达)及33.3%(低表达)χ2=7.73,P0.01;差异均具有显著统计学意义。CK19、CD56与PCNA在PTC表达中的灵敏率为93.5%、15.2%、63.0%,特异度为69.0%、33.3%、42.9%。三者联合检测灵敏度为93.5%,特异度为73.9%。CK19、CD56与PCNA在BPH表达中的灵敏率为31.0%、66.7%、33.3%,特异度为6.5%、84.8%、37.0%。三者联合检测灵敏度为66.7%,特异度为69.0%。结论 CK19、CD56与PCNA在甲状腺乳头状癌与良性乳头状增生中的表达有显著差别,可以对二者进行鉴别诊断,联合测定提高灵敏性及特异性。     

Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion

Aim The aim of this study is to evaluate the outcome of different modes of resection in papillary thyroid carcinoma (PTC) with laryngotracheal invasion.Materials and methods Sixty-four primary PTCs with laryngotracheal invasion between 1964 and 2003 were retrospectively analyzed (17 men and 47 women; mean age, 61.6 years; mean follow-up, 92.3 months). Thirteen curative resections included six pharyngolaryngoesophagectomies, two total laryngectomies, and five circumferential resections (complete surgery). Eighteen patients who were candidates for curative resection refused to undergo complete surgery to avoid functional impairment, especially laryngeal function (incomplete surgery). Thirty-three patients with minimal invasion underwent shave or partial resection (conservative surgery). Clinical outcomes were compared between the three groups. The influence of different types of surgery and invasion was also evaluated by Cox proportional hazard analysis.Results Three (23.1%) complete, 17 (94.4%) incomplete, and 4 (13.8%) conservative surgery patients died of disease (P < 0.0001). The 10-year disease-specific survival (Kaplan–Meier) in complete, incomplete, and conservative surgery patients were 62.9, 11.1, and 87.7%, respectively (log rank test, P < 0.0001). Incomplete surgery related to worse prognosis [p < 0.0001; hazard ratio (HR), 12.9) than complete or conservative surgery. Tracheal deep invasion (p = 0.0019, HR 7.6) and larynx invasion (p < 0.0001, HR 9.9) related to worse prognosis than minimal invasion.Conclusion Curative resection improves clinical outcomes in PTCs with laryngotracheal invasion. Conservative resection for minimal invasion also can achieve favorable prognosis. The degree of tumor invasion is significantly related to survival.     

多灶性甲状腺微小乳头状癌临床病理特征及预防性中央区淋巴结清扫的意义

目的:探讨多灶性甲状腺微小乳头状癌(PTMC)临床病理特征及预防性中央区淋巴结清扫的意义。方法:回顾湘雅医院甲状腺外科2013年7月—2016年12月收治的270例PTMC患者资料,比较多灶PTMC与单灶性PTMC患者临床病理因素的差异,并分析多灶性PTMC中央区淋巴结转移的危险因素。结果:270例患者中共120例多灶性PTMC(44.4%)。与单灶性PTMC患者比较,多灶性PTMC患者男性比例增加、中央区淋巴结转移与包膜侵犯发生率明显升高(均P0.05)。多灶PTMC患者的肿瘤最大直径(5~10mmvs.5mm)及是否存在包膜侵犯与中央区淋巴结转移发生率有关(均P0.05),而病灶的数目(2vs.≥3)及分布(单侧vs.双侧)与中央区淋巴结的转移发生率无关(均P0.05)。结论:多灶性PTMC较单灶PTMC具有较差的临床病理特征,中央区淋巴结转移风险增加。多灶性PTMC行预防性中央区淋巴结清扫是很有必要的,尤其对于是肿瘤较大、有包膜侵犯的患者。     

Insular carcinomas of the thyroid exhibit poor prognosis and long-term survival in comparison to follicular and papillary T4 carcinomas

Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore, in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer. Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors. Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%). Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage who have follicular or papillary thyroid carcinoma.     

Long-term follow-up of node-positive papillary thyroid carcinomas

Introduction: We retrospectively reviewed the data of patients with papillary thyroid cancer who were node positive and treated at our department between 1955 and 1994. Of 362 cases of papillary cancer, 134 were identified with lymph-node metastases (37%). Methods: Two types of dissection procedures were applied by a large community of surgeons. When only the cervical central lymph nodes were involved, the procedure of choice was thyroidectomy, with local lymph-node excision (LD); if the lateral nodes were also affected, modified radical neck dissection (MRND) was applied. Results: Of 88 patients considered to have minimal involvement, 70 underwent procedures of a lesser magnitude than MRND. Most of the operations were localised “picking procedures”. Recurrence of the disease developed in 16 cases, twice in 8 of these. The new tumourous lymph node was found to be ipsilateral in every case and close to the place of the first operation. The rate of recurrence was 23%. In the same group, 18 MRNDs were performed, with ipsilateral lymph-node recurrence in six cases. In 41 patients undergoing surgery for extended lymph-node metastases, conservative excisions were carried out in 17 and MRND in 24 cases, including six bilateral dissections. In this group, late recurrence was 47%. Conclusion: The results of the follow-up of 30 childhood and juvenile patients with papillary thyroid carcinoma is very interesting; all of our young patients are alive. Received: 5 February 1998     

多灶性甲状腺乳头状癌的临床病理及颈淋巴结转移特征

目的:探讨多灶性甲状腺乳头状癌(PTC)的临床病理及颈淋巴结转移特征。方法:回顾性分析2016年6月—2016年10月于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理证实的323例PTC患者的临床资料,其中多灶性PTC患者148例,单灶性PTC患者175例。结果:多灶性PTC患者与单灶性PTC患者间性别、年龄、癌灶最大径差异无统计学意义(均P0.05),但前者更易发生颈部中央区淋巴结转移(P0.001)、颈侧区淋巴结转移(P=0.028)及腺外浸润(P0.001);多灶性PTC患者中,癌灶数≥3的患者中央区淋巴结转移率(P=0.010)、侧区淋巴结转移率(P=0.018)及腺外浸润的发生率(P=0.020)明显高于癌灶数=2的患者;多因素分析显示,癌灶最大径(P=0.005)及癌灶数量(P=0.006)为多灶性PTC中央区淋巴结转移的独立危险因素。结论:多灶性PTC较单灶性PTC侵袭性强,更易发生转移、浸润,建议选择全甲状腺切除加中央区淋巴结清扫作为标准化手术方式,颈侧区存在可疑肿大淋巴结者应积极行颈侧区淋巴结清扫术。     

甲状腺乳头状癌几种侵袭性亚型的研究进展

甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)是最常见的甲状腺恶性肿瘤,约占所有甲状腺癌的80%[1].其有多灶性累及腺体和淋巴结转移的倾向,但大部分病例预后良好,10年生存率超过90%～95%[2].近40年来的研究表明PTC的生物学性质与肿瘤细胞特殊的细胞学特点有关,而与乳头生长形式本身无关.