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Abstract
Purpose
The major issue of follicular thyroid carcinoma (FTC) diagnosed after hemithyroidectomy is whether to undergo further treatments. The aim of this study is to examine the clinicopathological characteristics of FTC and to evaluate the risk factors for distant metastasis.
Methods
From 1993 to 2010, 274 patients underwent initial thyroid surgery and were subsequently diagnosed as FTC. After review of the histological sections by an experienced pathologist, 211 patients were confirmed as FTC and were enrolled in this study. Clinicopathological features were compared based on the presence or absence of distant metastases, and the risk factors for distant metastases and distant metastases-free survival (DMFS) rates were analyzed.
Results
The patients included 39 males (18.5%) and 172 females (81.5%), with a mean age of 44.0±14.5 years. The median follow-up period was 99.5 months (range, 13.0∼222.0). Distant metastases were detected in 23 patients (10.9%), including 15 synchronous distant metastases and 8 metachronous distant metastases. In multivariate analysis, age ≥45 years, widely invasive FTC, tumor size ≥4.3 cm, and vascular invasion were independent risk factors for distant metastasis. DMFS rates in patients with these risk factors were significantly poorer than those in patients without these risk factors.
References
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Fig. 1.
The algorithm of selection for eligible patients in this study. All Hemotoxylin and eosin slides were reviewed by an experienced pathologist (DE Song). FA = follicular adenoma; cPTC = classical papillary thyroid carcinoma; FTC = follicular thyroid carcinoma; FVPTC = follicular variant papillary thyroid carcinoma; HA = Hurthle cell adenoma; SVPTC = solid variant papillary thyroid carcinoma; MIFTC = minimally thyroid carcinoma; WIFTC = widely invasive follicular thyroid carcinoma.
Fig. 2.
Distant metastasis free survival rates according to the independent risk factors. (A) Age, (B) histological classification, (C) primary tumor size, (D) the presence of vascular invasion.
Table 1.
clinicopathological characteristics of patients with follicular thyroid carcinoma
| N=211 | N (%) |
|---|---|
| Sex | |
| Female | 172 (81.5) |
| Male | 39 (18.5) |
| Age (years) | |
| Mean±SD (range) | 44.01±14.45 (13∼78) |
| ＜45 | 112 (53.1) |
| ≥45 | 99 (46.9) |
| Surgical extent | |
| Hemithyroidectomy | 97 (46.0) |
| Total thyroidectomy | 114 (54.0) |
| Lymph node dissection | |
| No | 148 (70.1) |
| CCND | 63 (29.9) |
| Diagnosis | |
| Minimally invasive | 195 (92.4) |
| Widely invasive | 16 (7.6) |
| Tumor size (cm) | |
| Mean±SD (range) | 3.95±2.08 (0.5∼15) |
| Thyroiditis | |
| No | 195 (92.4) |
| Yes | 16 (7.6) |
| Extrathyroidal extension | |
| No | 154 (73.0) |
| Yes | 57 (27.0) |
| Vascular invasion | |
| No | 160 (75.8) |
| Yes | 51 (24.2) |
| RAI ablation* | |
| No | 6 (7.0)* |
| Yes | 108 (93.0)* |
| Distant metastasis | |
| No | 88 (89.1) |
| Yes | 23 (10.9) |
| Synchronous | 15 |
| Metachronous | 8 |
| Final status | |
| No evidence of disease | 188 (89.1) |
| Alive with disease | 13 (6.2) |
| Death | 10 (4.7) |
Table 2.
Univariate and multivariate analysis for distant metastasis in the patients with follicular thyroid carcinoma
| N=211 | NED 188 (89.1%) | Distant metastasis 23 (10.9%) |
Univariate |
Multivariate |
||
|---|---|---|---|---|---|---|
| Hazard ratio (95% CI) | P | Hazard ratio (95% CI) | P | |||
| Sex | ||||||
| Female | 156 (83.0) | 16 (69.6) | Ref. | |||
| Male | 32 (17.0) | 7 (30.4) | 2.4 (0.97∼5.93) | 0.075 | ||
| Age (years) | ||||||
| ＜45 | 108 (57.4) | 4 (17.4) | Ref. | Ref. | ||
| ≥45 | 80 (42.6) | 19 (82.6) | 5.79 (1.97∼17.02) | 0.001 | 3.5 (1.08∼11.36) | 0.037 |
| Surgical extent | ||||||
| Hemithyroidectomy | 94 (50.0) | 3 (13.0) | Ref. | Ref. | ||
| Total thyroidectomy | 94 (50.0) | 20 (87.0) | 5.61 (1.66∼18.9) | 0.005 | 2.74 (0.76∼9.91) | 0.125 |
| Lymph node dissection | ||||||
| No | 137 (72.9) | 11 (47.8) | Ref. | Ref. | ||
| CCND | 51 (27.1) | 12 (52.2) | 2.72 (1.2∼6.2) | 0.017 | 2.35 (0.83∼5.57) | 0.082 |
| Final pathologic diagnosis | ||||||
| Minimally invasive | 180 (95.7) | 15 (65.2) | Ref. | Ref. | ||
| Widely invasive | 8 (4.3) | 8 (34.8) | 11.27 (4.5∼28.19) | ＜0.001 | 3.11 (1.04∼9.32) | 0.043 |
| Tumor size (cm) | ||||||
| ≤4.3* | 126 (67.0) | 7 (30.4) | Ref. | Ref. | ||
| ＞4.3* | 62 (33.0) | 16 (69.6) | 4.31 (1.77∼10.5) | 0.001 | 3.56 (1.35∼9.36) | 0.01 |
| Thyroiditis | ||||||
| No | 172 (91.5) | 23 (100.0) | Ref. | |||
| Yes | 16 (8.5) | 0 (0) | 0.044 (0∼45.07) | 0.38 | ||
| Extrathyroidal extension | ||||||
| No | 137 (72.9) | 17 (73.9) | Ref. | |||
| Yes | 51 (27.1) | 6 (26.1) | 1.02 (0.4∼2.59) | 0.97 | ||
| Vascular invasion | ||||||
| No | 149 (79.3) | 11 (47.8) | Ref. | Ref. | ||
| Yes | 39 (20.7) | 12 (52.2) | 3.32 (1.46∼7.53) | 0.004 | 2.45 (1.05∼5.71) | 0.038 |
| RAI ablation | ||||||
| No | 98 (52.1) | 5 (21.7) | Ref. | Ref. | ||
| Yes | 90 (47.9) | 23 (78.3) | 3.43 (1.27∼9.27) | 0.015 | 2.56 (0.80∼8.94) | 0.088 |
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