放射性碘难治性滤泡性和肿瘤性甲状腺癌的临床和组织病理学风险因素

IF 5 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Endocrinology & Metabolism Pub Date : 2024-11-18 DOI:10.1210/clinem/dgae084

Merel T Stegenga, Evert F S van Velsen, Lindsey Oudijk, Frederik A Verburg, Tessa M van Ginhoven, Robin P Peeters, Marco Medici, W Edward Visser, Folkert J van Kemenade

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引用次数: 0

摘要

导言：滤泡性甲状腺癌（FTC）和癌细胞性甲状腺癌（OTC）放射性碘（RAI）难治性疾病的风险因素尚不清楚。因此，本研究旨在通过广泛的组织病理学检查，确定FTC和OTC患者RAI难治性疾病的临床和组织病理学风险因素：回顾性纳入2000年至2016年期间在荷兰伊拉斯姆斯医学院（Erasmus MC）接受治疗的所有FTC和OTC成人患者。2015年ATA指南用于定义RAI难治性疾病。利用Palga：荷兰病理学数据库，采用2022年世卫组织分类进行了广泛的组织病理学修订。采用逻辑回归确定RAI难治性疾病的风险因素，并根据组织学亚型进行分层：共纳入了90名FTC和52名OTC患者，其中14名FTC患者（15.6%）和22名OTC患者（42.3%）在8.5年的随访期间出现了RAI难治性疾病。OTC患者RAI难治性疾病的发生周期少于FTC（2.0 [IQR: 1.0-2.0] vs 2.5 [IQR: 2.0-3.75]），而且RAI难治性疾病大大降低了10年疾病特异性生存率，尤其是OTC（46.4%；FTC 85.7%）。在 FTC 中，风险因素包括确诊时年龄较大、pT3/pT4 期、N1 期、广泛浸润性肿瘤和甲状腺外扩展。在OTC中，N1期和M1期是最强的风险因素，而不是原发肿瘤的组织病理学特征：据我们所知，这是第一项将临床和组织病理学风险因素与FTC和OTC的RAI难治性疾病相关联的研究，并通过组织病理学改良得以实现。在FTC中，RAI难治性疾病的风险因素主要是原发肿瘤的组织病理学特征，而在OTC中，淋巴结和远处转移与RAI难治性疾病相关。我们的数据有助于临床决策，尤其是对有 RAI 难治性疾病风险的患者。

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Clinical and Histopathological Risk Factors for Radioactive Iodine-Refractory Follicular and Oncocytic Thyroid Carcinoma.

Context: Risk factors for radioactive iodine (RAI)-refractory disease in follicular (FTC) and oncocytic thyroid carcinoma (OTC) are unknown.

Objective: The aim of this study is to identify clinical and histopathological risk factors for RAI-refractory disease in FTC and OTC patients, facilitated by an extensive histopathological revision.

Methods: All adult FTC and OTC patients treated at Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. The 2015 American Thyroid Association guidelines were used to define RAI-refractory disease. An extensive histopathological revision was performed applying the 2022 World Health Organization Classification using PALGA, the Dutch Pathology Databank. Logistic regression was used to identify risk factors for RAI-refractory disease, stratified by histological subtype.

Results: Ninety FTC and 52 OTC patients were included, of whom 14 FTC (15.6%) and 22 OTC (42.3%) patients developed RAI-refractory disease over a follow-up time of 8.5 years. RAI-refractory disease occurred in OTC after fewer cycles than in FTC (2.0 [interquartile range (IQR): 1.0-2.0] vs 2.5 [IQR: 2.0-3.75]), and it substantially decreased 10-year disease-specific survival, especially in OTC (46.4%; FTC 85.7%). In FTC, risk factors were higher age at diagnosis, pT3/pT4 stage, N1 stage, widely invasive tumors, and extrathyroidal extension. N1 stage and M1 stage were the strongest risk factors in OTC, rather than histopathological characteristics of the primary tumor.

Conclusion: To our knowledge, this is the first study that correlates clinical and histopathological risk factors with RAI-refractory disease in FTC and OTC, facilitated by a histopathological revision. In FTC, risk factors for RAI-refractory disease were foremost histopathological characteristics of the primary tumor, whereas in OTC presentation with lymph node and distant metastasis was associated with RAI-refractory disease. Our data can help clinical decision-making, particularly in patients at risk for RAI-refractory disease.

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来源期刊

Journal of Clinical Endocrinology & Metabolism 医学-内分泌学与代谢

CiteScore

11.40

自引率

5.20%

发文量

673

审稿时长

1 months

期刊介绍： The Journal of Clinical Endocrinology & Metabolism is the world"s leading peer-reviewed journal for endocrine clinical research and cutting edge clinical practice reviews. Each issue provides the latest in-depth coverage of new developments enhancing our understanding, diagnosis and treatment of endocrine and metabolic disorders. Regular features of special interest to endocrine consultants include clinical trials, clinical reviews, clinical practice guidelines, case seminars, and controversies in clinical endocrinology, as well as original reports of the most important advances in patient-oriented endocrine and metabolic research. According to the latest Thomson Reuters Journal Citation Report, JCE&M articles were cited 64,185 times in 2008.