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Horm Metab Res 2023; 55(05): 323-332
DOI: 10.1055/a-2032-5810
Original Article: Endocrine Care

Do Histologically Aggressive Subtypes of Papillary Thyroid Microcarcinoma have Worse Clinical Outcome than Non-Aggressive Papillary Thyroid Microcarcinoma Subtypes? A Multicenter Cohort Study

Sayid Shafi Zuhur 
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Hunkar Aggul
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Ugur Avci
2   Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
,
Selvinaz Erol
3   Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
,
Mazhar Müslüm Tuna
4   Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
,
Serhat Uysal
5   Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Gulhan Akbaba
6   Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
,
Faruk Kilinç
7   Department of Endocrinology and Metabolism, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
,
Merve Catak
8   Department of Endocrinology and Metabolism, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
,
Sakin Tekin
9   Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
,
Ogun Irem Bilen
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Beyza Olcay Öztürk 
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Ecem Bilgehan Erden
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Gulsah Elbuken 
1   Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Halise Cinar Yavuz
4   Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
,
Pinar Kadioglu
5   Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Nese Cinar
6   Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
,
Faruk Kutluturk
7   Department of Endocrinology and Metabolism, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
,
Taner Bayraktaroglu
9   Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
,
Birol Topçu
10   Department of Biostatistics, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Aysegul Isal Arslan
11   Department of Pathology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
,
Hasan Gucer
12   Department of Pathology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
,
Gulcin Cihangiroglu
13   Department of Pathology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
,
Cumhur Selcuk Topal
14   Department of Pathology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
,
Tulin Ozturk
15   Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
,
Leyla Tekin
16   Department of Pathology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
,
Gokhan Artas
17   Department of Pathology, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
,
Elif Akcay
18   Department of Pathology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
,
Banu Dogan Gun
19   Department of Pathology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
,
Yuksel Altuntas
3   Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Abstract

Histologically aggressive micropapillary thyroid carcinomas (PTMC) subtypes are thought to be associated with an aggressive clinical course. However, evidence for unfavorable clinical outcomes in patients with aggressive PTMC subtypes is not clear. In this study, we intended to determine the difference in clinical outcomes between patients with aggressive and non-aggressive PTMC subtypes. In this multicenter cohort study, the computer-recorded clinical and histopathological data of patients who underwent thyroid surgery between January 2000 - January 2021 in 9 referral centers and were diagnosed as PTMC were analyzed. A total of 1585 patients [female 1340 (84.5%), male 245 (15.5%), mean age 47.9±11.63 years), with a mean follow-up time of 66.55±37.16 months], were included in the study. Ninety-eight cases were diagnosed as aggressive and 1487 as non-aggressive subtypes. Persistent/recurrent disease was observed in 33 (33.7% )and 41 (2.8%) patients with aggressive and non-aggressive subtypes (p<0.001). Diseases-free survival rates were markedly lower in patients with aggressive than in those with non-aggressive PTMC subtypes (66.3 vs. 94.8%, log-rank p<0.001). Moreover, in multivariate analysis, aggressive histology was an independent predictor of persistent/recurrent disease, after controlling for other contributing factors (HR 5.78, 95% CI 3.32–10, p<0.001). Patients with aggressive PTMC subtypes had higher rates of incomplete biochemical and structural response than patients with non-aggressive subtypes as well (p<0.001). Aggressive PTMC subtypes share many characteristics with histologically identical tumors>1 cm in size. Therefore, the histopathological subtype of PTMC should be taken into consideration to tailor a personalized management plan.

Key words

papillary microcarcinoma - aggressive subtype - clinical outcome


Publication History

Received: 01 December 2022

Accepted after revision: 10 February 2023

Accepted Manuscript online:
10 February 2023

Article published online:
06 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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