Mariana Caldeira, Sule Canberk, Sofia Macedo, Miguel Melo, Valdemar Máximo, Paula Soares
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引用次数: 0
Abstract
The 5th edition of the WHO Classification of Tumors of Endocrine Organs introduced the term Differentiated High-Grade Thyroid Carcinoma (DHGTC) to identify cases of differentiated follicular cell-derived thyroid carcinomas (DFCDTC) with a worse prognosis. This study aimed to determine the frequency and clinicopathological features of DHGTC within a cohort of advanced follicular cell-derived thyroid carcinomas (AdvTC) and compare them to non-high-grade DFCDTC (non-HGDTC) and poorly differentiated thyroid carcinoma (PDTC). A retrospective analysis was conducted on 138 patients with AdvTC who underwent total thyroidectomy followed by radioactive iodine therapy (131I). DHGTC was identified in 15.9% of the cases (22/138), showing a higher prevalence in this selected cohort of AdvTC compared to other studies. Compared to non-HGDTC, DHGTC was significantly associated with adverse clinicopathological features, including age ranges ≤ 18 and ≥ 55 years, presence of distant and synchronous metastasis, larger tumor size (> 2 cm), tall-cell subtype of papillary thyroid carcinoma, higher mitotic index (≥ 5/2 mm2), tumor necrosis, angioinvasion, higher AJCC 8th edition pT stage (pT3/T4), and more frequent administration of additional therapies, such as tyrosine kinase inhibitors. In comparison to PDTC, DHGTC displayed lower median tumor size, less frequent tumor necrosis, and a higher mitotic count. Independent prognostic factors for worse DSS in the entire cohort were age ≥ 55 years (HR = 19.625, p = 0.005) and male sex (HR = 7.441, p = 0.029). DHGTC cases consistently demonstrated worse clinical outcomes compared to non-HGDTC, including lower survival rates and higher persistence of disease at the end of follow-up. Our results validate the inclusion of DHGTC as a distinct high-grade subgroup within follicular cell-derived thyroid carcinomas, as proposed by the 5th WHO classification. DHGTC exhibits aggressive clinicopathological features and poor outcomes, supporting its relevance in clinical risk stratification and therapeutic decision-making.
期刊介绍:
Manuscripts of original studies reinforcing the evidence base of modern diagnostic pathology, using immunocytochemical, molecular and ultrastructural techniques, will be welcomed. In addition, papers on critical evaluation of diagnostic criteria but also broadsheets and guidelines with a solid evidence base will be considered. Consideration will also be given to reports of work in other fields relevant to the understanding of human pathology as well as manuscripts on the application of new methods and techniques in pathology. Submission of purely experimental articles is discouraged but manuscripts on experimental work applicable to diagnostic pathology are welcomed. Biomarker studies are welcomed but need to abide by strict rules (e.g. REMARK) of adequate sample size and relevant marker choice. Single marker studies on limited patient series without validated application will as a rule not be considered. Case reports will only be considered when they provide substantial new information with an impact on understanding disease or diagnostic practice.