Comparison of clinical, laboratory and tumor characteristics and evaluation of risk factors in patients with papillary thyroid carcinoma and microcarsinoma

Yıl 2018, , 118 - 125, 25.06.2018

Narin Nasıroğlu İmga , Hakan Ataş , Dilek Berker Gül Dağlar

https://doi.org/10.18663/tjcl.409856

Öz

Aim: Papillary thyroid carcinoma (PTC) is one of the most commonly seen cancers with good prognosis and requires long-term follow-up. Papillary thyroid microcarcinoma (PTMC) is defined as a PTC size ≤10 mm in large diameter. Advanced age, tumor size, number of tumor foci and presence of extrathyroidal extension, pathological lymph node (LN), and distant metastasis affect PTC prognosis negatively. Our aim was to compare clinical, laboratory and tumor characteristics of PTC and PTMC patients

Material and Method: A total of 302 PTC patients who underwent total thyroidectomy between April 2014 and October 2017 in Ankara Numune Education and Research Hospital were evaluated retrospectively. Postoperative tumor size, number of foci, localization and extrathyroidal extension status were recorded.

Results: Patients were 80.8% female, 19.2% male. The mean age was 46.48 ± 12.3, while the body mass index (BMI) was 30.4 ± 5.2. No difference was found in terms of age, BMI, and gender between the groups of PTMC (n=172) and PTC (n=130). PTC is more frequently seen in patients with hypertension, diabetes, and non-thyroidal malignancy, while PTMC is more frequent in those with primary hypothyroidism. Unifocal tumors were more frequent in the PTMC group, whereas tumor focuses between 3-9 were more frequent in the PTC group (p = 0.012). The extrathyroidal extension rate was higher in PTC group (p <0.001). Neck LN metastasis was more prevalent in the PTC group (p = 0.022), but there was no significant difference between the neck LN metastases regions between PTC and PTMC groups (p = 0.807).

Conclusion: Despite the presence of large tumor size, multifocality, extrathyroidal extension and neck LN metastasis in PTC group, no difference was found between neck LN metastasis regions between PTMC and PTC patients. Careful examination of all neck regions for pathologic LN scan should be performed in PTC and PTMC patients.

Keywords: Papillary thyroid carcinoma, microcarcinoma, lymph node

Anahtar Kelimeler

Papillary thyroid carcinoma, microcarsinoma, macrocarsinoma

Papiller tiroid karsinomu ve mikrokarsinomu olan hastalarda klinik, laboratuvar ve tümör özelliklerinin karşılaştırılması ve risk faktörlerinin değerlendirilmesi

Öz

Amaç: Papiller tiroid kanserleri karsinomu (PTK) en sık görülen kanserlerden biri olup prognozu iyi seyretmekle beraber ömür boyu takip gerektirir. Tümörün en büyük çapı ≤10 mm ise papiller mikrokarsinom (PTMK) olarak adlandırılır. İleri yaş, tümör boyutu, odak sayısı fazlalığı, ekstratiroidal ekstansiyon, patolojik lenf nodu (LN) ve uzak metastaz varlığı PTK prognozunu olumsuz etkiler. Amacımız PTK ve PTMK hastalarında klinik, laboratuvar ve tümör özelliklerini karşılaştırmaktır.

Gereç ve Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesinde Nisan 2014 ve Ekim 2017 tarihleri arasında total tiroidektomi yapılan 302 PTK hastası retrospektif olarak incelendi. Postoperatif tümör boyutu, tümör odak sayısı, lokalizasyonu ve ekstratiroidal ekstansiyon durumu kaydedildi.

Bulgular: Hastalar %80,8 kadın, %19,2 erkekti. Yaş ortalaması 46,48±12,3 iken vücut kitle indeksi (VKİ) 30.4±5.2 idi. PTMK (n=172) ve PTK (n=130) grupları arasında yaş, VKİ ve cinsiyet açısından fark yoktu. Hipertansiyon, diyabet ve tiroid dışı malignite öyküsü olanlarda PTK daha sıkken primer hipotiroidi öyküsü olanlarda PTMK daha sıktı. Tek odaklı tümörü olanlar PTMK grubunda daha fazla iken 3-9 arasında tümör odağı bulunanlar PTK grubunda daha fazlaydı (p=0.012). Ekstratiroidal ekstansiyon oranı PTK olanlarda daha yüksekti (p<0.001). Ayrıca PTK grubunda boyun LN metastazı varlığı daha fazla iken (p=0.022), her iki grupta LN metastazı olanlarda boyun metastazı görülen bölgeler açısından anlamlı fark saptanmadı (p=0.807).

Sonuç: PTMK ve PTK hastaları karşılaştırıldığında tümör boyutu, odak sayısı, ekstratiroidal ekstansiyonu ve boyun LN metastazı varlığı PTK grubunda daha fazla olmasına rağmen her iki grupta LN metastazı görülen bölgeler arasında anlamlı fark saptanmadı. Tüm PTK ve PTMK hastalarında tedavi seçimi ve takibi yapılırken boyun bölgeleri patolojik LN taraması açısından dikkatle incelenmelidir.

Anahtar Kelimeler

Papiller tiroid kanseri, mikrokarsinom, makrokarsinom

Kaynakça

• 1. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998; 338: 297–306.
• 2. Sherman SI. Thyroid carcinoma. Lancet 2003; 361: 501–11.
• 3. Kuo SF, Lin SF, Chao TC, Hsueh C, Lin KJ, Lin JD. Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol 2013; 2013
• 4. Mazzaferri EL. Management of low-risk differentiated thyroid cancer. Endocr Pract 2007; 13: 498-512.
• 5. Hay ID. Management of patients with low-risk papillary thyroid carcinoma. Endocr Pract 2007; 13: 521-33
• 6. Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26: 1-33.
• 7. Katoh R, Sasaki J, Kurihara H, Suzuki K, Iida Y, Kawaoi A. Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients. Cancer 1992; 70: 1585–90.
• 8. So YK, Kim MW, Son YI. Multifocality and bilaterality of papillary thyroid microcarcinoma. Clin Exp Otorhinolaryngol 2015; 8: 174.
• 9. Qu N, Zhang L, Ji Q-H et al. Number of tumor foci predicts prognosis in papillary thyroid cancer. BMC Cancer 2014; 14: 914.
• 10. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC. Volumetric analysis of thyroid lobes by real-time ultrasound (author's transl). Dtsch Med Wochenschr. 1981; 106: 1338-40.
• 11. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90.
• 12. Jung KW, Won YJ, Kong HJ et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer research and treatment: official journal of Korean Cancer Association. 2015; 47: 127.
• 13. Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014; 140: 317-22.
• 14. Ceylan B, Özerdoğan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Turk J Obstet Gynecol 2015; 12: 43.
• 15. Sakoda LC, Horn-Ross PL. Reproductive and menstrual history and papillary thyroid cancer risk: the San Francisco Bay Area thyroid cancer study. Cancer Epidemiol Biomarkers Prev 2002; 11: 51-7.
• 16. Candanedo-Gonzalez FA, Gamboa-Dominguez A. Postmenopause is associated with recurrence of differentiated papillary thyroid carcinoma. Med Hypotheses 2007; 69: 209-13.
• 17. Yeo Y, Ma SH, Hwang Y et al. Diabetes mellitus and risk of thyroid cancer: a meta-analysis. PloS one. 2014; 9: e98135.
• 18. Harari A, Endo B, Nishimoto S, Ituarte PH, Yeh MW. Risk of advanced papillary thyroid cancer in obese patients. Arch Surg 2012; 147: 805-11.
• 19. Satman I, Omer B, Tutuncu Y et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-80.
• 20. Kim KW, Park YJ, Kim EH et al. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis. Head & neck 2011; 33: 691-95.
• 21. Al Afif A, Williams BA, Rigby MH et al. Multifocal papillary thyroid cancer increases the risk of central lymph node metastasis. Thyroid 2015; 25: 1008-12.
• 22. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg 2005; 71: 731-4
• 23. Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 2014; 24: 27-34