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Thyroid. 2019 Aug 9. doi: 10.1089/thy.2019.0263. [Epub ahead of print]

Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma.

Author information

1
Brigham and Women\'s Hospital, Pathology, 75 Francis St, Boston, Massachusetts, United States, 02446; kwong21@partners.org.
2
Dana Farber Cancer Institute, 1855, Head and Neck Oncology, 850 Brookline Ave, D2136, Boston, Massachusetts, United States, 02115; jochen_lorch@dfci.harvard.edu.
3
Brigham and Women's Hospital, Endocrinology, Hypertension, and Diabetes, Boston, Massachusetts, United States; ekalexander@bwh.harvard.edu.
4
Brigham and Womens Hospital, Boston, United States; emarqusee@partners.org.
5
Brigham & Women's Hospital, Surgery, 75 Francis Street, Boston, Massachusetts, United States, 02115; nlcho@partners.org.
6
Brigham and Women's Hospital , Surgery, Boston, Massachusetts, United States; mnehs@bwh.harvard.edu.
7
Brigham & Women's Hospital and Harvard Medical School, Surgery, 75 Francis St, Boston, Massachusetts, United States, 02115; gmdoherty@bwh.harvard.edu.
8
Brigham and Women's Hospital, Pathology, 75 Francis Street, Boston, Massachusetts, United States, 02115; jbarletta@partners.org.

Abstract

BACKGROUND:

Extent of invasion has been shown to be prognostic in follicular thyroid carcinoma and Hürthle cell carcinoma. Our aim was to evaluate how extent of invasion impacts clinical outcome for poorly differentiated thyroid carcinoma (PDTC).

DESIGN:

We retrospectively identified 47 consecutively diagnosed cases of PDTC that were resected between 2005 and 2018. All cases were reviewed to confirm that the tumors met the 2017 Endocrine WHO criteria of PDTC. Additionally, tumors were categorized as follows: encapsulated with capsular penetration only, encapsulated with focal vascular invasion (fewer than 4 foci), encapsulated with extensive vascular invasion (4 or more foci), or widely invasive. Histopathologic characteristics and clinical outcome data were recorded.

RESULTS:

47 cases of PDTC, including 15 oncocytic tumors, were identified from 28 (60%) women and 19 (40%) men (mean age of 57 years at diagnosis). The mean tumor size was 4.3 cm. Mitoses numbered 8 per 10 high-power fields on average (range: 1-34), and necrosis was present in 21 (45%) cases. Eight (17%) cases were encapsulated with capsular penetration only, 5 (11%) were encapsulated with focal vascular invasion, 18 (38%) were encapsulated with extensive vascular invasion, and 16 (34%) were widely invasive. Of the 42 (89%) cases with follow-up data, 7 (17%) died of disease (with a mean survival time of 6.4 years), 11 (26%) have distant metastatic disease, and 24 (57%) patients have no evidence of disease (mean follow-up 5.6 years). Eight (19%) patients presented with M1 disease at diagnosis. The 5-year disease-free survival for patients with M0 disease at diagnosis was 100% for patients with tumors with capsular invasion only or focal vascular invasion (n=7), 73% for patients with encapsulated tumors with extensive vascular invasion (n=11), and 17% for patients with widely invasive PDTC (n=6). Disease-free survival estimates by Kaplan-Meier analysis were significantly different between these groups (p = 0.0016).

CONCLUSION:

Extent of invasion appears to be an important parameter that affects clinical outcome for patients with PDTC. In our cohort, patients with encapsulated PDTC with capsular invasion only or focal vascular invasion had an excellent outcome.

PMID:
31397224
DOI:
10.1089/thy.2019.0263

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