Papillary thyroid microcarcinoma: distinct form or cancer growth stage?

V. Solodkiy, D. Fomin, D. A. Galushko, H. Asmaryan
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Abstract

Background. Over the past decades an increase in the incidence of papillary thyroid microcarcinoma (PTMC) has been observed throughout the world owing to the improved diagnostics. There are many different opinions about the aggressiveness degree of this group of tumors, as well as about the tactics of managing patients with PTMC.Aim of the study is the identification of the prognostic factors responsible for the features of the clinical course, including the more aggressive one.Materials and methods. A study was carried out with a detailed analysis of a group of patients with papillary thyroid cancer ≤1 cm in size and the existing clinical data of regional and distant metastases. All patients underwent thyroidectomy with bilateral central cervical lymph node dissection. Factors such as gender, patient age, bilaterality, extrathyroid extension, the presence or absence of a capsule around the tumor node, the absence or presence of metastases in the central part were assessed. In 26.6% histological examination revealed metastatic lesions of the central group lymph nodes. Latent metastases were detected in 24.2% of women and 43% of men, in 36.7% of patients <55 and in 14.3% of patients ≥ 55 years, in 29.5% with the absence of the node capsule and in 19.3% with encapsulated tumors, in 48.1% with multicentric growth and in 19.5% with a solitary neoplasm, in 21.7% with a tumor size ≤0.5 cm and in 27.9% with a node of 0.6–1 cm, in 24% with the absence of invasion of the thyroid capsule and in 31% with the presence of extrathyroid invasion, in 21% of patients with typical, in 26% with follicular and 43% with mixed papillary cancer. 95 patients received radioiodine therapy. No additional metastases were found in them.Results. When conducting univariate analysis, the main signs influencing the development of metastases in the central zone were age up to 55 years (p = 0.009, χ2 = 6.919) and multicentric neoplasm (p = 0.004, χ2 = 8.530); in multivariate analysis, similarly, age younger 55 years (p = 0.000, Exp B = 0.011, CI 95.0% 0.001–0.106) and multifocality (p = 0.027, Exp B = 2.686, CI 95.0% 1.119–6.448).Conclusion. PTMC is not a separate group or tumor morphotype, and the determination of treatment tactics for this group of patients should be based not only on the size of the tumor, but on the clinical and biological parameters of the tumor.
乳头状甲状腺微小癌:不同形式还是癌症生长阶段?
背景在过去的几十年里,由于诊断方法的改进,世界各地的甲状腺乳头状微小癌(PTMC)的发病率都有所增加。关于这组肿瘤的侵袭性程度,以及PTMC患者的治疗策略,有很多不同的意见。本研究的目的是确定导致临床病程特征的预后因素,包括更具侵袭性的因素。材料和方法。对一组尺寸≤1cm的甲状腺乳头状癌癌症患者进行了详细分析,并对区域和远处转移的现有临床数据进行了分析。所有患者均接受甲状腺切除术,同时进行双侧颈中央淋巴结清扫。评估了性别、患者年龄、双侧性、甲状腺外延伸、肿瘤结节周围是否存在包膜、中心部位是否存在转移等因素。26.6%的组织学检查显示中心组淋巴结转移灶。24.2%的女性和43%的男性、36.7%的<55岁和14.3%的≥55岁患者、29.5%的无淋巴结包膜和19.3%的包膜肿瘤、48.1%的多中心生长和19.5%的孤立性肿瘤、21.7%的肿瘤大小≤0.5 cm和27.9%的淋巴结为0.6–1 cm,24%的患者没有甲状腺包膜侵袭,31%的患者有甲状腺外侵袭,21%的患者有典型侵袭,26%的患者有毛囊侵袭,43%的患者有混合性癌症侵袭。95例接受放射性碘治疗。未发现其他转移灶。后果在进行单变量分析时,影响中心区转移发展的主要迹象是年龄高达55岁(p=0.009,χ2=6.919)和多中心肿瘤(p=0.004,χ2=8.530);在多变量分析中,同样,年龄小于55岁(p=0.000,Exp B=0.011,CI 95.0%0.001–0.106)和多灶性(p=0.027,Exp B=2.686,CI 95.0%1.119–6.448),但取决于肿瘤的临床和生物学参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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