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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 50-55

Clinicopathological, immunohistochemical factors and recurrence associated with extrathyroidal extension in papillary thyroid microcarcinoma


1 Department of Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Korea
2 Department of Surgery, Anam Hospital, Seoul, Korea
3 Department of Surgery, Korea University College of Medicine, Ansan Hospital, GyeongGi-Do, Korea

Correspondence Address:
Jae Bok Lee
Department of Surgery, Korea University College of Medicine Guro Hospital 97 Guro-dong gil, Guro-gu, Seoul, 152-703
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131366

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Background and Aims: Extrathyroidal extension (ETE) is one of the most important factors correlated to poor outcome of papillary thyroid carcinoma (PTC). However, the role of ETE in the prognosis of papillary thyroid microcarcinoma (PTMC) and the factor associated with ETE of PTMC are unclear. We investigated clinicopathological, immunohistochemical factors associated with ETE of PTMC to identify whether PTMC with ETE would have more adverse prognostic factors and higher risk for recurrence. Setting and Design: We enrolled patients performed thyroidectomy due to PTC between January 2003 and June 2008 and selected patients diagnosed with PTMC among them. We investigated numerous clinicopathological, immunohistochemical factors of selected patients. Materials and Methods: Data from 325 patients diagnosed with conventional PTMC by intraoperative frozen section and final pathology were recorded retrospectively. Statistical Analysis Used: A χ2 test or an independent two-sample t-test, multiple logistic regression analysis, the Kaplan-Meier method, and log-rank test. Results: Thirty-four percent of patients (325 of 952) had PTMC on final pathology. Among them, the number of patients with and without ETE was 91 and 234, respectively. On both univariate and multivariate analysis; ETE of PTMC correlated with size (P < 0.001); tumor, node, and metastasis (TNM) staging (P = 0.001); multifocality (P = 0.001); lymph node metastasis (P < 0.001); radioactive iodine (RAI) therapy (P = 0.001); and recurrence (P = 0.037). Conclusions: ETE of conventional PTMC is associated with size, multifocality, lymph node metastasis, and recurrence. More extensive surgery should be considered for patients having ETE identified by intraoperative frozen sections, preoperative imaging, and intraoperative finding and other high risk factors.

Abstract in Chinese

甲状腺微小乳头状癌中甲状腺外扩散的临床病理学、免疫组化因素和复发相关性 背景和目的:甲状腺外扩散(ETE)是甲状腺乳头状癌(PTC)不良预后中的一个重要因素。然而,ETE在甲状腺微小乳头状癌(PTMC)预后判断的作用,以及ETE与PTMC相关性还不清楚。我们研究了PTMC的ETE临床病理、免疫组化因素,以确认是否PTMC合并ETE存在不良预后因素和高复发风险。 设置和设计:入组的病人系2003.1~2008.6行因甲状腺乳头状癌行甲状腺切除术的病人,并对诊断为甲状腺微小乳头状癌的病人进行临床病理、免疫组化因素分析。 材料和方法:325例PTMC病例的数据,包括术中冰冻和术后最终病理结果被分别记录。 统计分析方法: χ2 检测或独立双样本t-检测,多元回归分析,Kaplan-Meier法,以及对数检测。 结果:34%病例(325/952)最终病理报告为甲状腺微小乳头状癌。他们当中,有和没有ETE的分别为91例和234例。同时运用单变量和多变量分析; ETE和PTMC相关因素:大小(P<0.001);TNM分期(P=0.001);多病灶(P=0.001);淋巴结转移(P<0.001); 放射性碘(RAI)治疗(P=0.001);复发(P=0.037)。 结论:传统PTMC与ETE相关因素有肿瘤大小,多病灶,淋巴转移,复发。如果术中冰冻,术前影像,术中探查证实为ETE,或有其它高风险因素,需考虑更广泛的手术切除。 关键词:甲状腺外扩散,淋巴结转移,多发灶,甲状腺微小乳头状癌,大小



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