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Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma.
Thyroid 2019; 29(9):1255-1261T

Abstract

Background:

The 2017 World Health Organization (WHO) Classification of Tumors of Endocrine Organs defines poorly differentiated thyroid carcinoma (PDTC) as a tumor with conventional criteria of malignancy (capsular penetration or vascular invasion) with solid, insular, or trabecular growth, a lack of nuclear features of papillary thyroid carcinoma, and increased mitotic activity, tumor necrosis, or convoluted nuclei. The 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 PDTC.

Methods:

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. In addition, tumors were categorized as follows: encapsulated with capsular penetration only, encapsulated with focal vascular invasion (fewer than four foci), encapsulated with extensive vascular invasion (four or more foci), or widely invasive. Histopathologic characteristics and clinical outcome data were recorded.

Results:

A total of 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 (HPF) 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%) patients 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%) 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 (DFS) 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 PDTCs (n = 6). DFS estimates by Kaplan-Meier analysis were significantly different between these groups (p = 0.0016).

Conclusions:

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.

Authors+Show Affiliations

Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31397224

Citation

Wong, Kristine S., et al. "Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma." Thyroid : Official Journal of the American Thyroid Association, vol. 29, no. 9, 2019, pp. 1255-1261.
Wong KS, Lorch JH, Alexander EK, et al. Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma. Thyroid. 2019;29(9):1255-1261.
Wong, K. S., Lorch, J. H., Alexander, E. K., Marqusee, E., Cho, N. L., Nehs, M. A., ... Barletta, J. A. (2019). Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma. Thyroid : Official Journal of the American Thyroid Association, 29(9), pp. 1255-1261. doi:10.1089/thy.2019.0263.
Wong KS, et al. Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma. Thyroid. 2019;29(9):1255-1261. PubMed PMID: 31397224.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic Significance of Extent of Invasion in Poorly Differentiated Thyroid Carcinoma. AU - Wong,Kristine S, AU - Lorch,Jochen H, AU - Alexander,Erik K, AU - Marqusee,Ellen, AU - Cho,Nancy L, AU - Nehs,Matthew A, AU - Doherty,Gerard M, AU - Barletta,Justine A, PY - 2019/8/10/pubmed PY - 2019/8/10/medline PY - 2019/8/10/entrez KW - angioinvasion KW - poorly differentiated thyroid carcinoma KW - prognosis KW - widely invasive SP - 1255 EP - 1261 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 29 IS - 9 N2 - Background: The 2017 World Health Organization (WHO) Classification of Tumors of Endocrine Organs defines poorly differentiated thyroid carcinoma (PDTC) as a tumor with conventional criteria of malignancy (capsular penetration or vascular invasion) with solid, insular, or trabecular growth, a lack of nuclear features of papillary thyroid carcinoma, and increased mitotic activity, tumor necrosis, or convoluted nuclei. The 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 PDTC. Methods: 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. In addition, tumors were categorized as follows: encapsulated with capsular penetration only, encapsulated with focal vascular invasion (fewer than four foci), encapsulated with extensive vascular invasion (four or more foci), or widely invasive. Histopathologic characteristics and clinical outcome data were recorded. Results: A total of 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 (HPF) 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%) patients 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%) 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 (DFS) 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 PDTCs (n = 6). DFS estimates by Kaplan-Meier analysis were significantly different between these groups (p = 0.0016). Conclusions: 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. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/31397224/Prognostic_Significance_of_Extent_of_Invasion_in_Poorly_Differentiated_Thyroid_Carcinoma L2 - https://www.liebertpub.com/doi/full/10.1089/thy.2019.0263?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -