PARIS (EGMN) – Vascular invasion is highly predictive of long-term survival in thyroid cancer, and its presence or absence should be considered when determining a patient’s postsurgical follow-up plan, an investigator concluded from long-term follow-up of 725 patients.
Vascular invasion was present in 30% of the entire patient cohort. Their survival rates at 5, 10, and 20 years were significantly worse than the rates seen among those patients without vascular invasion (89% vs. 98%; 75% vs. 96%; and 70% vs. 92%, respectively).
“This is a very important prognostic factor for both follicular and papillary thyroid cancer,” Dr. Francoise Bonichon said at the International Thyroid Congress.
“If vascular invasion is present, the risk of thyroid cancer–related death is higher, and we classify the patient as ‘intermediate risk,’ with radioiodine ablation, suppression of thyroid-stimulating hormone, and follow-up every year that includes thyroglobulin and ultrasound,” she reported.
“If, on the other hand, there is no vascular invasion, we classify the patient as ‘low risk,’ except if there is another poor prognostic factor. This patient does not receive radioiodine ablation, and we keep the TSH normal.”
Dr. Bonichon of the Institut Bergonié in Bordeaux presented the long-term follow-up data on patients treated at the hospital from 1960 to 2008. All had histologically confirmed nonmetastatic thyroid cancer with a tumor size of more than 1 cm. Most of the tumors (594) were papillary. Follicular thyroid cancer was confirmed in 128 patients; the remainder had poorly differentiated thyroid tumors.
Most of the patients (75%) were women; their mean age at diagnosis was 48 years. The median follow-up period was 12 years. About a quarter (22%) had already been exposed to neck radiation, most of them for Hodgkin’s disease.
For the analysis, Dr. Bonichon and her colleagues described vascular invasion as a cluster of tumor cells attached to the wall or protruding into the lumen of a vessel located at the periphery of the tumor, within or immediately outside the tumor capsule.
At the last follow-up, 70% of the cohort was alive with no evidence of thyroid cancer, 3% were alive with thyroid cancer, and 10% were dead from thyroid cancer. Another 2% were alive with other cancers, and 3% were dead from other cancers. In addition, 4% were alive with no information on health status, 7% had died from other problems, and 1% was lost to follow-up.
At 5 years, the overall survival rate was 92%; at 10 years, it was 83%. Those with papillary thyroid cancer had the best cancer-specific survival rates at 5, 10, and 20 years (98%, 95%, and 90%, respectively). Follicular cancer followed (95%, 85%, and 67%, respectively). Poorly differentiated cancers had the lowest survival rates (70%, 65%, and 40%, respectively).
“In our multivariate analysis, vascular invasion was as significant a risk factor for poor prognosis as age older than 45 years, tumor size more than 4 cm, and nodal status,” Dr. Bonichon said. “Vascular invasion is a simple, inexpensive factor that we can use in conjunction with age and other postoperative staging factors to tailor our decisions about radioiodine ablation, TSH suppression, and follow-up intensity.”
Dr. Bonichon had no potential conflicts of interest.
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巴黎(EGMN)——法国Bergonié研究所Francoise Bonichon博士在最近召开的国际甲状腺大会上报告称，血管侵犯可很好地预测甲状腺癌患者长期生存率，其存在与否可作为制定患者术后随访计划的考虑因素。
研究者对1960~2008年间住院治疗的725例甲状腺癌患者进行了长期随访。他们均为组织学确认的非转移甲状腺癌患者，肿瘤大于1 cm。其中594例为乳头状癌，128例为滤泡状癌，其余为低分化甲状腺癌。75%的患者为女性，平均诊断年龄为48岁，中位随访时间为12年。
结果表明，发生血管侵犯的患者占所有随访者的30% ，其5年、10年和20年的生存率显著低于无血管侵犯者(分别为89% 对 98%、 75% 对 96%和 70%对92%)。经多变量分析后发现，血管侵犯是年龄大于45岁、肿瘤大于4 cm及淋巴结受累患者预后不良的重要风险因素。此外，随访者5年和10年总体生存率分别为92%和83%。乳头状癌患者5年、10年及20年癌症相关生存率最高(分别为98%、95%和90%)，滤泡状癌患者其次(分别为95%、85%和67%)，低分化癌患者生存率最差(分别为70%、65%和40%)。
总之，无论对滤泡状癌还是乳头状癌，血管侵犯都是一个非常重要的预后因素。血管侵犯检测方法简便、价格低廉，可联合年龄及其他术后分期因素，用以调整患者放射性碘消融、促甲状腺激素抑制治疗以及随访强度的决策。
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