TY - JOUR
T1 - Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants
AU - Shi, Xiaoguang
AU - Liu, Rengyun
AU - Basolo, Fulvio
AU - Giannini, Riccardo
AU - Shen, Xiaopei
AU - Teng, Di
AU - Guan, Haixia
AU - Shan, Zhongyan
AU - Teng, Weiping
AU - Musholt, Thomas J.
AU - Al-Kuraya, Khawla
AU - Fugazzola, Laura
AU - Colombo, Carla
AU - Kebebew, Electron
AU - Jarzab, Barbara
AU - Czarniecka, Agnieszka
AU - Bendlova, Bela
AU - Sykorova, Vlasta
AU - Sobrinho-Simães, Manuel
AU - Soares, Paula
AU - Shong, Young Kee
AU - Kim, Tae Yong
AU - Cheng, Sonia
AU - Asa, Sylvia L.
AU - Viola, David
AU - Elisei, Rossella
AU - Yip, Linwah
AU - Mian, Caterina
AU - Vianello, Federica
AU - Wang, Yangang
AU - Zhao, Shihua
AU - Oler, Gisele
AU - Cerutti, Janete M.
AU - Puxeddu, Efisio
AU - Qu, Shen
AU - Wei, Qing
AU - Xu, Huixiong
AU - O'Neill, Christine J.
AU - Sywak, Mark S.
AU - Clifton-Bligh, Roderick
AU - Lam, Alfred K.
AU - Riesco-Eizaguirre, Garcilaso
AU - Santisteban, Pilar
AU - Yu, Hongyu
AU - Tallini, Giovanni
AU - Holt, Elizabeth H.
AU - Vasko, Vasily
AU - Xing, Mingzhao
PY - 2016/1
Y1 - 2016/1
N2 - Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data demonstrating differential risks of PTC variants to support. Objective: This study sought to establish the differential clinicopathological risk of major PTC variants: conventional PTC (CPTC), follicular-variant PTC (FVPTC), and tall-cell PTC (TCPTC). Methods: Thiswasa retrospective study of clinicopathological outcomes of 6282 PTC patients (4799 females and 1483 males) from 26 centers and The Cancer Genome Atlas in 14 countries with a median age of 44 years (interquartile range, 33â€"56 y) and median follow-up time of 37 months (interquartile range, 15â€"82 mo). Results: The cohort consisted of 4702 (74.8%) patients with CPTC, 1126 (17.9%) with FVPTC, and 239 (3.8%) with TCPTC. The prevalence of high-risk parameters was significantly different among the three variants, including extrathyroidal invasion, lymph node metastasis, stages III/IV, disease recurrence, mortality, and the use (need) of radioiodine treatment (all P > .001), being highest in TCPTC, lowest in FVPTC, and intermediate in CPTC, following an order of TCPTC>CPTC蠑FVPTC. Recurrence and mortality in TCPTC, CPTC, and FVPTC were 27.3 and 6.7%, 16.1 and 2.5%, and 9.1 and 0.6%, corresponding to events per 1000 person-years (95% confidence interval [CI]) of 92.47 (64.66â€"132.26) and 24.61 (12.31â€" 49.21), 34.46 (30.71â€"38.66), and 5.87 (4.37â€"7.88), and 24.73 (18.34 â€"33.35) and 1.68 (0.54 â€"5.21), respectively. Mortality hazard ratios of CPTC and TCPTC over FVPTC were 3.44 (95% CI, 1.07â€"11.11) and 14.96 (95% CI, 3.93â€"56.89), respectively. Kaplan-Meier survival analyses showed the best prognosis in FVPTC, worst in TCPTC, and intermediate in CPTC in disease recurrence-free probability and disease-specific patient survival. This was particularly the case in patients at least 45 years old. Conclusion: This large multicenter study demonstrates differential prognostic risks of the three major PTC variants and establishes a unique risk order of TCPTC > CPTC 蠑 FVPTC, providing important clinical implications for specific variant-based management of PTC.
AB - Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data demonstrating differential risks of PTC variants to support. Objective: This study sought to establish the differential clinicopathological risk of major PTC variants: conventional PTC (CPTC), follicular-variant PTC (FVPTC), and tall-cell PTC (TCPTC). Methods: Thiswasa retrospective study of clinicopathological outcomes of 6282 PTC patients (4799 females and 1483 males) from 26 centers and The Cancer Genome Atlas in 14 countries with a median age of 44 years (interquartile range, 33â€"56 y) and median follow-up time of 37 months (interquartile range, 15â€"82 mo). Results: The cohort consisted of 4702 (74.8%) patients with CPTC, 1126 (17.9%) with FVPTC, and 239 (3.8%) with TCPTC. The prevalence of high-risk parameters was significantly different among the three variants, including extrathyroidal invasion, lymph node metastasis, stages III/IV, disease recurrence, mortality, and the use (need) of radioiodine treatment (all P > .001), being highest in TCPTC, lowest in FVPTC, and intermediate in CPTC, following an order of TCPTC>CPTC蠑FVPTC. Recurrence and mortality in TCPTC, CPTC, and FVPTC were 27.3 and 6.7%, 16.1 and 2.5%, and 9.1 and 0.6%, corresponding to events per 1000 person-years (95% confidence interval [CI]) of 92.47 (64.66â€"132.26) and 24.61 (12.31â€" 49.21), 34.46 (30.71â€"38.66), and 5.87 (4.37â€"7.88), and 24.73 (18.34 â€"33.35) and 1.68 (0.54 â€"5.21), respectively. Mortality hazard ratios of CPTC and TCPTC over FVPTC were 3.44 (95% CI, 1.07â€"11.11) and 14.96 (95% CI, 3.93â€"56.89), respectively. Kaplan-Meier survival analyses showed the best prognosis in FVPTC, worst in TCPTC, and intermediate in CPTC in disease recurrence-free probability and disease-specific patient survival. This was particularly the case in patients at least 45 years old. Conclusion: This large multicenter study demonstrates differential prognostic risks of the three major PTC variants and establishes a unique risk order of TCPTC > CPTC 蠑 FVPTC, providing important clinical implications for specific variant-based management of PTC.
UR - http://www.scopus.com/inward/record.url?scp=84954493972&partnerID=8YFLogxK
U2 - 10.1210/jc.2015-2917
DO - 10.1210/jc.2015-2917
M3 - Article
C2 - 26529630
AN - SCOPUS:84954493972
SN - 0021-972X
VL - 101
SP - 264
EP - 274
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 1
ER -