Papillary thyroid carcinoma: different clinical behavior among pT3 tumors
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ORIGINAL ARTICLE
Papillary thyroid carcinoma: different clinical behavior among pT3 tumors Maria Joana Santos1,2 • Maria Joa˜o Bugalho1,3
Received: 10 January 2016 / Accepted: 12 March 2016 Ó Springer Science+Business Media New York 2016
Abstract pT3 papillary thyroid carcinoma (PTC) can be divided into three subgroups according to the largest diameter [4 cm or evidence of minimal extrathyroidal extension (ETE): A [4 cm, no ETE; B B4 cm, with ETE; and C [4 cm, with ETE. The aim of this study was to analyze whether these subgroups are clinically different. A retrospective analysis of clinicopathological data of patients with pT3 PTC, with a minimum follow-up of 2 years, at a referral center was conducted. Outcome was evaluated after primary treatment and after 2 and 5 years of follow-up. Patients were classified as no evidence of disease (NED), biochemical evidence of disease (BED), and structural evidence of disease (SED) either locoregional (SED-L) or at distance (SED-D). The study patients were classified into three groups as follows: Group A (n = 91), Group B (n = 101), and Group C (n = 23). Most patients were female (80.0 %); mean age at diagnosis was 49.9 ± 16.5 years. 214 patients underwent total thyroidectomy; 208 patients were treated with 131I. Median follow-up was 6.0 years. After primary treatment, the condition of NED was significantly different between the groups (A—87.9 %, B—68.3 %, C—43.5 %; p \ 0.001). Recurrence rate, either biochemical or structural, was 8.8, 7.2, and 30.0 % in groups A, B, and C, respectively.
& Maria Joana Santos [email protected] 1
Endocrinology Department, Instituto Portugueˆs de Oncologia de Lisboa Francisco Gentil E.P.E., Rua Prof. Lima Basto, 1099-023 Lisbon, Portugal
2
Endocrinology Department, Hospital de Braga, Braga, Portugal
3
NOVA Medical School/Faculdade de Cieˆncias Me´dicas, Universidade Nova de, Lisbon, Portugal
Clinical status after 2 years anticipated clinical status after 5 years, except for Group B. ETE and tumor size were found to be predictors of disease status after primary treatment and after 2 years. ETE appeared as the strongest predictor of persistence of disease after primary treatment as well as of evidence of disease, either biochemical or structural, after 2 years of follow-up. Keywords Papillary thyroid carcinoma pT3 Minimal extrathyroidal extension Tumoral size Prognosis
Introduction Papillary thyroid carcinoma (PTC) is the most frequent differentiated thyroid carcinoma (DTC) and its incidence has been progressively rising [1–3]. According to the 5th edition of the Tumor, Node, Metastasis/American Joint Cancer Committee staging system (TNM/AJCC), one of the most widely used, all PTCs with extrathyroidal extension, independently of size, were classified as T4. In 2002, the 6th edition of the TNM classification introduced a major change. Tumors with minimal extrathyroidal extension (ETE), regardless of size, were downgraded to T3 [4]. The same criterion persists in the 7th TNM edition the one currently in use. Under the pT3
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