Tiroid Papiller Mikrokarsinomunda Prognostik Faktörler

Öz

Amaç: Bu retrospektif çalışmadaki amacımız, tiroid papiller mikrokarsinom prognozunda önemli olan faktörleri değerlendirmektir. Gereç ve Yöntem: Çalışmaya Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi Patoloji bölümünde, 2010-2020 yılları arasında tanı konulan, 178 hastaya ait 277 tiroid papiller mikrokarsinom nodülü dahil edildi. Tümör çapı, unilateralite, bilateralite, multifokalite, tümör odak sayısı, fibrozis, kapsüle uzaklık ve Gal-3, HBME-1 ve CK19 boyanmasının prognostik önemi olup olmadığını, lenfovasküler invazyon, lenf nodu metastazı, kapsül invazyonu ve tiroid dışı yayılım ile karşılaştırarak retrospektif olarak araştırıldı. Ayrıca immün boyalar ile fibrozis arasındaki ilişki araştırıldı. Bulgular: Tümör çapının >0,5 olması ve lenf nodu metastazı arasında anlamlı ilişki bulundu. Unilateralite, bilateralite, multifokalite ve tümör odak sayısı, lenfovasküler invazyon ve lenf nodu metastazı ile ilişkiliydi. Fibrozis, kapsül invazyonu ve ekstratiroidal yayılım ile ilişkiliydi. CK-19 prevalansı ve lenf nodu metastazı ile, Gal-3 prevalansı ve kapsüler invazyon ve tiroid dışı yayılım arasında ilişki bulundu. Fibrozis ile galektin3 ve CK19 yoğunlukları arasında pozitif, HBME-1 ile negatif korelasyon bulundu. Sonuç: Negatif prognostik belirteçler >0,5 tümör çapı, unilateralite, bilateralite, multifokalite, tümör odak sayısı, fibrozisdir. CK-19 prevalansı ve lenf nodu metastazı ile Gal-3 prevelansı ve kapsüler invazyon ve tiroid dışı yayılım arasında ilişki bulundu. Fibrozis ile galektin3 ve CK19 yoğunlukları arasında pozitif, HBME-1 ile negatif korelasyon bulundu. Anahtar Kelimeler: Tiroid papiller mikrokarsinom, prognoz, fibrozis, Gal-3, HBME-1, CK19, fibrozis.

Anahtar Kelimeler

• Tiroid papiller mikrokarsinom
• prognoz
• Gal-3
• CK19
• fibrozis
• HBME-1

Prognostic Factors in Thyroid Papillary Microcarcinoma

Öz

Aim: Our aim in this retrospective study is to evaluate the factors that are important in the prognosis of thyroid papillary microcarcinoma. Material and Method: This study is a retrospective study. In the study, 277 thyroid papillary microcarcinoma nodules belonging to 178 patients, diagnosed in Kütahya University of Health Sciences Hospital, between 2010 and 2020, were included. The prognostic significance of tumor diameter, unilaterality, bilaterality, multifocality, number of tumor foci, fibrosis, distance from the capsule and Gal-3, HBME-1 and CK19 staining were investigated retrospectively by comparing with negative prognostic factors such as lymphovascular invasion, lymph node metastasis, capsular invasion and extrathyroidal spread. Moreover, the relationship between immunostains and fibrosis was examined. Results: The significant association was found between >0.5 tumor diameter and lymph node metastasis. Unilaterality, bilaterality, multifocality and number of tumor foci was associated with lymphovascular invasion and lymph node metastasis. Fibrosis was associated with capsular invasion and extrathyroidal spread. A correlation was found between the prevalence of Gal- 3 and capsular invasion and extrathyroidal spread, and between the prevalence of CK-19 and lymph node metastasis. A positive correlation was found between fibrosis and Gal-3 and CK19, and negative correlations with HBME-1 intensity. Conclusion: Negative prognostic markers are >0.5 tumor diameter, unilaterality, bilaterality, multifocality, number of tumor foci, fibrosis, Gal-3 and CK19 prevalence. A positive correlation was found between fibrosis and Gal-3 and CK19, and negative correlation with HBME-1 intensity.

Anahtar Kelimeler

• Thyroid papillary microcarcinoma
• prognosis
• Gal-3
• CK19
• fibrosis
• HBME-1

Kaynakça

1. 1. Lloyd RV, Osamura RY, Klöppel G, Rosai J. World Health Organization. Classificiation of Tumours:Pathology and Genetics of Tumours of the Endocrine Organs. 10th ed. Lyon;IARC Press:2017.
2. 2. Goran M, Markovic I, Buta M, et al. The influence of papillary thyroid microcarcinomas size on the occurrence of lymph node metastases. J BUON 2019;24(5):2120-6.
3. 3. Slijepcević N, Zivaljevic V, Marinkovic J, Šipetić-Grujičić S, Diklic A, Paunovic I. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015;15:330.
4. 4. Zheng W, Wang K, Wu J, Wang W, Shang J. Multifocality is associated with central neck lymph node metastases in papillary thyroid microcarcinoma. Cancer Manag Res 2018;10:1527-33. 5. Zhang Q, Wang Z, Meng X, Duh QY, Chen G. Predictors for central lymph node metastases in CN0 papillary thyroid microcarcinoma (mPTC):A retrospective analysis of 1304 cases. Asian J Surg 2019;42(4):571-6.
5. 6. Kwak J.Y, Kim EK, Kim MJ, et al. Papillary microcarcinoma of the thyroid:predicting factors of lateral neck node metastasis. Ann Surg Oncol 2009;16:1348–55.
6. 7. Apostol D.C, Giusca S.E, Caruntu I.D, Lozneanu L, Andriescu E.C, Moscalu M. Relationships between clinicopathological prognostic factors in papillary thyroid microcarcinoma:A refined analysis based on 428 cases. Int J Clin Exp Pathol 2017;10:8944–56.
7. 8. Lin DZ, Qu N, Shi RL, Lu ZW, Ji QH, Wu WL. Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma. Onco Targets Ther 2016;9:5307-16.
8. 9. Lee HS, Park HS, Kim SW, et al. Clinical characteristics of papillary thyroid microcarcinoma less than or equal to 5 mm on ultrasonography. Eur Arch Otorhinolaryngol 2013;270:2969-74.

9. 10. Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH. Papillary microcar cinoma of the thyroid prognostic significance of lymph node metastasis and multifocality. Cancer 2003;98:31–40.
10. 11. Kim E, Choi J, Koo do H, Lee K, Youn Y. Differences in the characteristics of papillary thyroid microcarcinoma ≤5 mm and >5 mm in diameter. Head Neck 2015;37:694-7.
11. 12. Friguglietti CU, Dutenhefner SE, Brandão LG, Kulcsar MA. Classification of papillary thyroid microcarcinoma according to size and fine-needle aspiration cytology:Behavior and therapeutic implications. Head Neck 2011;33:696-701.
12. 13. Iscan Y, Sormaz IC, Tunca F, Senyurek YG. Multicentricity Is More Common in Thyroid Papillary Microcancer with a Preoperative Diagnosis Compared to Incidental Microcancer. Eur Thyroid J 2019;8:256–61.
13. 14. Zhou YL, Gao EL, Zhang W, et al. Factors predictive of papillary thyroid microcarcinoma with bilateral involvement and central lymph node metastasis:a retrospective study. World J Surg Oncol 2012;10(1):67–72.
14. 15. Guo Y, Liu Z, Yu P, et al. Using foci number to predict central lymph node metastases of papillary thyroid microcarcinomas with multifocality. Int J Clin Exp Med 2015;8:9925-30.
15. 16. Isarangkul W. Dense fibrosis. Another diagnostic criterion for papillary thyroid carcinoma. Arch Pathol Lab Med 1993;117:645–66.
16. 17. Liu X, Zhang S, Gang Q, et al. Interstitial fibrosis in papillary thyroid microcarcinoma and its association with biological behavior. Oncol Lett 2018;15(4):4937-43.
17. 18. Arcolia V, Journe F, Renaud F, et al. Combination of galectin-3, CK19 and HBME-1 immunostaining improves the diagnosis of thyroid cancer. Oncol Lett 2017;14(4):4183-9.
18. 19. Zheng J, Lu W, Wang C, Xing Y, Chen X, Ai Z. Galectin-3 induced by hypoxia promotes cell migration in thyroid cancer cells. Oncotarget 2017;8(60):101475-88.
19. 20. Liu LZ, Yang LX, Zheng BH, et al. CK7/CK19 index:a potential prognostic factor for postoperative intrahepatic cholangiocarcinoma patients. J Surg Oncol 2018;117:1531–9.
20. 21. Dencic TI, Cvejic D, Paunovic I, Tatic S, Havelka M, Savin S. Cytokeratin19 expression discriminates papillary thyroid carcinoma from other thyroid lesions and predicts its aggressive behavior. Med Oncol 2013;30:362.
21. 22. Menz A, Bauer R, Kluth M, et al. Diagnostic and prognostic impact of cytokeratin 19 expression analysis in human tumors:a tissue microarray study of 13,172 tumors. Hum Pathol 2021;115:19-36.
22. 23. Viana AOR, Goncalves Filho J, Francisco ALN, Pinto CAL, Kowalski LP. Ki-67 and CK-19 are predictors of locoregional recurrence in papillary thyroid carcinoma. Acta Otorhinolaryngol Ital 2020;40:190-7.