Risk Factors Associated With Recurrence and Death in Patients With Tall Cell Papillary Thyroid Cancer
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Published:2023-01-01
Issue:1
Volume:149
Page:79
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ISSN:2168-6181
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Container-title:JAMA Otolaryngology–Head & Neck Surgery
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language:en
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Short-container-title:JAMA Otolaryngol Head Neck Surg
Author:
Wu Shannon S.1, Joshi Nikhil2, Sharrett Jonathan3, Rao Sanjay4, Shah Akeesha5, Scharpf Joseph6, Burkey Brian7, Lamarre Eric D.6, Prendes Brandon6, Siperstein Allan8, Shin Joyce9, Berber Eren9, Jin Judy9, Krishnamurthi Vikram9, Nasr Christian9, Hong Li10, Buchberger David S.3, Woody Neil3, Koyfman Shlomo A.3, Geiger Jessica L.11
Affiliation:
1. Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 2. Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois 3. Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio 4. Case Western Reserve University School of Medicine, Cleveland, Ohio 5. Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio 6. Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio 7. Department of Otolaryngology, Cleveland Clinic, Vero Beach, Florida 8. Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio 9. Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio 10. Department of Statistics, Cleveland Clinic, Cleveland, Ohio 11. Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
Abstract
ImportanceTall cell morphology (TCM) is a rare and aggressive variant of papillary thyroid carcinoma (PTC) that has been associated with poor outcomes; however, the risk factors for worse survival are not well characterized.ObjectiveTo identify prognostic factors associated with cancer recurrence and death in patients with PTC-TCM.Design, Setting, and ParticipantsAll patients treated for PTC-TCM at a single tertiary-level academic health care institution from January 1, 1997, through July 31, 2018, were included. Tall cell variant (TCV) was defined as PTC with TCM of 30% or more; and tall cell features (TCF) was defined as PTC with TCM of less than 30%. Patients with other coexisting histologic findings and/or nonsurgical management were excluded. Clinicopathologic features associated with worse outcomes were identified using Kaplan-Meier and Cox proportional-hazards model. Data were analyzed from March 1, 2018, to August 15, 2018.Main Outcomes and MeasuresLocoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and overall survival (OS) after surgery.ResultsA total of 365 patients (median [range] age, 51.8 [15.9-91.6] years; 242 [66.3%] female) with PTC-TCM (TCV, 32%; TCF, 68%) were evaluable. Total thyroidectomy was performed in 336 (92%) patients; 19 (5.2%) received radiotherapy; and 15 (4.1%) received radioactive iodine. Clinical features were pT3 or T4, 65%; node-positive, 53%; and positive surgical margins, 24%. LRRFS at 1-, 3-, 5-, and 10-year was 95%, 87%, 82%, and 73%, respectively. On multivariable analysis, male sex and age were not independent predictors of inferior 5-year LRRFS, whereas positive surgical margins (HR, 3.5; 95% CI, 2.0-6.3), positive lymph nodes (HR, 2.8; 95% CI, 1.4-5.8), and primary tumor size of 3 cm or more (HR, 3.3; 95% CI, 1.4-7.8) were strongly associated with worse LRRFS. Age 55 years or older (HR, 3.2; 95% CI, 1.5-7.0), male sex (HR 4.5; 95% CI, 2.1-10.0), positive surgical margins (HR, 2.7; 95% CI, 1.2-6.0), nodal positivity (HR, 3.1; 95% CI, 1.3-7.7), tumor diameter of 1.5 cm or more (HR, 20.6; 95% CI, 2.8-152.1), and TCV vs TCF (HR, 3.1; 95% CI, 1.5-6.7) were associated with worse DRFS. Male sex (HR, 3.1; 95% 1.4-6.8) and tumor diameter of 1.5 cm or more (HR, 2.8; 95% CI, 1.0-7.4) were associated with worse OS. A findings-based nomogram was constructed to predict 10-year LRRFS (C index, 0.8).Conclusions and RelevanceThis retrospective cohort study found that in patients with PTC-TCM, positive surgical margins, node positive disease, and tumor size of 3 cm or more were risk factors for worse LRRFS. Intensified locoregional therapy, including adjuvant radiation, may be considered for treating these patients.
Publisher
American Medical Association (AMA)
Subject
Otorhinolaryngology,Surgery
Cited by
6 articles.
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