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

Yıl 2018, Cilt: 9 Sayı: 2, 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

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