Diffuse sclerosing papillary thyroid carcinoma: Clinicopathological characteristics and prognostic implications compared with classic and tall cell papillary thyroid cancer Journal Article

   

Authors:	Scholfield, D. W.; Fitzgerald, C. W.; Alzumaili, B.; Eagan, A.; Xu, B.; Martinez, G.; Tuttle, R. M.; Shaha, A. R.; Shah, J. P.; Wong, R. J.; Patel, S. G.; Ghossein, R. A.; Ganly, I.
Article Title:	Diffuse sclerosing papillary thyroid carcinoma: Clinicopathological characteristics and prognostic implications compared with classic and tall cell papillary thyroid cancer
Abstract:	Background: The clinical behaviour and oncologic outcome of diffuse sclerosing papillary thyroid carcinoma (DS-PTC) is poorly understood. The objectives of this study were to compare the clinicopathological characteristics and oncological outcomes of DS-PTC to classic PTC (cPTC) and tall cell PTC (TC-PTC). Methods: After institutional review board approval, 86 DS-PTC, 2,080 cPTC, and 701 TC-PTC patients treated at MSKCC between 1986 and 2021 were identified. Clinicopathological characteristics were compared by using chi-square test. Kaplan-Meier and log rank were used to compare recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). DS-PTC patients were propensity matched to cPTC and TC-PTC patients for further comparison. Results: DS-PTC patients were younger with more advanced disease than cPTC and TC-PTC (p < 0.05). Lymphovascular invasion (LVI), extranodal extension, and positive margins were more common in DS-PTC (p < 0.02). Propensity matching confirmed more aggressive histopathological features in DS-PTC. The median number of metastatic lymph nodes was significantly greater and DS-PTC metastases were RAI avid. DS-PTC 5-year RFS was 50.4% compared with 92.4% in cPTC and 88.4% in TC-PTC (p < 0.001). Multivariate analysis confirmed DS-PTC as an independent prognostic factor of recurrence. Ten-year DSS for DS-PTC was 100% compared with 97.1% in cPTC and 91.1% in TC-PTC. Differentiated high-grade, thyroid carcinoma DS had more advanced T-stage and worse 5-year RFS than DS-PTC. Conclusions: DS-PTC presents with more advanced clinicopathological features than cPTC and TC-PTC. Large-volume nodal metastases and LVI are characteristic features. Almost half of patients develop recurrence despite aggressive initial management. Despite this, with successful salvage surgery DSS is excellent. © 2023, Society of Surgical Oncology.
Keywords:	adult; controlled study; human tissue; middle aged; survival analysis; cancer surgery; survival rate; retrospective studies; young adult; major clinical study; overall survival; case control study; clinical feature; histopathology; cancer recurrence; advanced cancer; cancer patient; comparative study; cancer staging; recurrence risk; lymph node metastasis; cancer grading; neoplasm recurrence, local; tumor differentiation; carcinoma, papillary; cohort analysis; pathology; retrospective study; risk factor; age; cancer center; radioactive iodine; tumor recurrence; thyroid neoplasms; papillary carcinoma; thyroid papillary carcinoma; thyroid tumor; disease specific survival; recurrence free survival; surgical margin; clinical outcome; independent variable; propensity score; cancer prognosis; lymph vessel metastasis; extranodal extension; humans; prognosis; human; male; female; article; thyroid cancer, papillary
Journal Title:	Annals of Surgical Oncology
Volume:	30
Issue:	8
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2023-08-01
Start Page:	4761
End Page:	4770
Language:	English
DOI:	10.1245/s10434-023-13589-y
PUBMED:	37154968
PROVIDER:	scopus
PMCID:	PMC10751659
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85158103872&doi=10.1245%2fs10434-023-13589-y&partnerID=40&md5=814f0b0f4c3d7ff879d555021e40a72f
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Ian Ganly -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/208215