Outcomes for Minimally Invasive Follicular Thyroid Carcinoma in Relation to the Change in Age Stratification in the AJCC
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ORIGINAL ARTICLE – ENDOCRINE TUMORS
Outcomes for Minimally Invasive Follicular Thyroid Carcinoma in Relation to the Change in Age Stratification in the AJCC 8th Edition Haruhiko Yamazaki, MD1 , Kiminori Sugino, MD, PhD1, Ryohei Katoh, MD, PhD2, Kenichi Matsuzu, MD, PhD1, Chie Masaki, MD1, Junko Akaishi, MD, PhD1, Kiyomi Yamada Hames, MD, PhD1, Chisato Tomoda, MD, PhD1, Akifumi Suzuki, MD1, Keiko Ohkuwa, MD, PhD1, Wataru Kitagawa, MD, PhD1, Mitsuji Nagahama, MD, PhD1, Munetaka Masuda, MD, PhD3, and Koichi Ito, MD, PhD1 Department of Surgery, Ito Hospital, Tokyo, Japan; 2Department of Pathology, Ito Hospital, Tokyo, Japan; 3Department of Surgery, Yokohama City University School of Medicine, Yokohama City, Japan 1
ABSTRACT Background. Completion total thyroidectomy with radioactive iodine (RAI) therapy is not uniformly recommended for minimally invasive follicular thyroid carcinomas (MI-FTCs) without distant metastasis, but may be considered for cases with a risk factor of recurrence, such as age C 45 years. Objective. The present study aimed to investigate the outcomes for patients with MI-FTC using a stratification age of 55 years. Methods. The records of 478 patients with MI-FTC confirmed by surgical specimens at Ito Hospital from January 2005 to December 2014 were retrospectively reviewed. Twenty patients had distant metastasis at diagnosis and were subsequently classified as M1. Results. Among the 478 patients with MI-FTC, univariate analysis identified that age C 55 years (p = 0.002) and M1 (p \ 0.001) were related to cause-specific survival. In 458 patients with M0 MI-FTC, male sex (p = 0.041), age C 55 years (p = 0.001), and tumor size [ 40 mm (p \ 0.001) were related to poor disease-free survival (DFS) in univariate analysis. Multivariate analysis showed that age C 55 years (p = 0.005) and tumor size [ 40 mm (p = 0.005) were independent prognostic factors for DFS.
Ó Society of Surgical Oncology 2020 First Received: 23 July 2020 Accepted: 1 November 2020 H. Yamazaki, MD e-mail: [email protected]
The 10-year DFS rates of patients aged \ 45 years, 45 years B age \ 55 years, and C 55 years were 97.0%, 95.5%, and 86.4%, respectively. Conclusions. The change in the recommended age for completion total thyroidectomy with RAI, from 45 to 55 years, seemed reasonable.
Follicular thyroid carcinoma (FTC) derives from follicular cells in the thyroid gland and is the second most common of all histological types of thyroid carcinoma.1 According to the World Health Organization (WHO) classification of thyroid tumors, FTC is defined by the presence of capsular and/or vascular invasion and by the absence of nuclear features typical of papillary thyroid carcinoma (PTC).2 FTC is more likely to metastasize to distant organs than to regional lymph nodes because of its tendency to invade blood vessels, resulting in hematogenous dissemination.3 In the third edition of the WHO classification, FTCs are divided into two major categories based on their degree of invasiveness. Minimally invasive FTCs (MI-FTCs) demonstrate limited
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