Prognostic factors for follicular thyroid carcinoma: the importance of vascular invasion

Ito, Yasuhiro; Hirokawa, Mitsuyoshi; Masuoka, Hiroo; Higashiyama, Takuya; Kihara, Minoru; Onoda, Naoyoshi; Miya, Akihiro; Miyauchi, Akira

doi:10.1507/endocrj.ej22-0077

Cited by 11 publications

(19 citation statements)

References 22 publications

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“…In this study, increasing tumour size significantly increased the risk of distant metastasis but not death from thyroid carcinoma . This finding is supported by studies showing increasing tumour size in follicular thyroid carcinomas correlating with an increased risk of distant metastasis [8, 9, 19]. In keeping with increasing tumour size as a poor prognostic factor, both the American Thyroid Association guidelines and European guidelines typically recommend a total thyroidectomy in minimally invasive follicular thyroid carcinomas ≥ 4 cm [13, 15].…”

Section: Discussionmentioning

confidence: 84%

“…Of all patients who developed distant metastasis, in > 50%, these were detected by the first RAI ablative dose. Other studies of angioinvasive follicular thyroid carcinoma report similar rates of distant metastasis [8, 9, 27]. Performing a total thyroidectomy upfront allows for determining biochemical response with serum thyroglobulin levels [28–30].…”

Section: Discussionmentioning

confidence: 97%

“…In addition, we show that the risk of distant metastasis occurring after initial therapy in patients with EAFTC tumours with < 4 foci during long‐term follow‐up (> 12 months) is very low (2.1%). Other studies also demonstrate EAFTC tumours represent a distinct higher risk category with higher rates of distant metastasis and reduced survival [6, 8, 10, 15, 19–23]. Two recent papers which stratified FTC by the number of foci show all FTC tumours with ≥ 2 foci angioinvasion are of increased risk of metastasis and reduced survival [12, 24].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies also demonstrate EAFTC tumours represent a distinct higher risk category with higher rates of distant metastasis and reduced survival [6, 8, 10, 15, 19–23]. Two recent papers which stratified FTC by the number of foci show all FTC tumours with ≥ 2 foci angioinvasion are of increased risk of metastasis and reduced survival [12, 24]. A large proportion of patients (> 50%) in the two recent studies [12, 24] did not receive RAI therapy, however, which may possibly account for the differences in outcomes in comparison to our study.…”

Section: Discussionmentioning

confidence: 99%

“…There is ongoing controversy regarding the extent of surgery and the need for adjuvant radioactive iodine (RAI) therapy based on the number of foci of angioinvasion in EAFTC. A few studies demonstrate that tumours with < 4 foci of angioinvasion are at low risk of distant metastasis and suggest no benefit from adjuvant RAI therapy [8–10]. Other studies, however, show that any number of angioinvasive foci pose a significant increased risk of distant metastasis [6, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma

et al. 2022

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Background Encapsulated angioinvasive follicular thyroid carcinoma (EAFTC) is associated with an increased risk of distant metastasis and reduced survival compared to minimally invasive follicular thyroid carcinoma (MIFTC). There is controversy regarding the extent of surgery and adjuvant radioactive iodine therapy for angioinvasive follicular thyroid carcinoma when stratified by number of foci of angioinvasion. Methods All follicular thyroid carcinoma cases from 1990–2018 were identified from a thyroid cancer database. Primary outcomes were distant metastasis‐free survival (DMFS) and disease‐specific survival (DSS) with factors of interest being age, gender, tumour size, treatment, foci of angioinvasion and histological subtype. Results A total of 292 cases were identified; 139 MIFTC, 141 EAFTC and 12 widely invasive follicular thyroid carcinoma (WIFTC). Over a follow‐up period of 6.25 years, DMFS was significantly reduced (p < 0.001) with 14.2% (EAFTC) and 50% of WIFTC developing metastasis. The risk of metastasis in EAFTC with ≥ 4 foci of angioinvasion was 31.7% (HR = 5.89, p = 0.004), 6.3% for EAFTC with < 4 foci of angioinvasion (HR = 1.74, p = 0.47), compared to 3.6% MIFTC. Age ≥ 50 years (HR = 4.24, p = 0.005) and tumour size (HR = 1.27, p = 0.014) were significantly associated with increased risk of distant metastasis. DSS was reduced significantly (p < 0.001), with 7.8% EAFTC patients dying of disease. For EAFTC patients, DSS was 96.8% for < 4 foci and 82.6% for ≥ 4 foci of angioinvasion (p = 0.003). Conclusion EAFTC is at increased risk of distant metastasis related to the extent of angioinvasion. Tumours with < 4 foci of angioinvasion should be considered for a total thyroidectomy, particularly in older patients.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma

et al. 2022

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Prognosis and influencing factors of follicular thyroid cancer

Shen,

Yan,

Chen

et al. 2023

Cancer Medicine

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ObjectivesFollicular thyroid cancer (FTC) is prone to distant metastasis, and patients with distant metastasis often have poor prognosis. In this study, the impact of metastasis and other relevant factors on the prognosis of follicular thyroid carcinoma was examined.MethodsThis was a retrospective study. Data were obtained from Zhejiang Cancer Hospital, Sun Yat‐sen University Cancer Center and Hangzhou First People's Hospital affiliated with Zhejiang University School of Medicine, from January 2009 to June 2021 for 153 FTC patients. The patients were assigned into three groups according to their distant metastasis: distant metastasis at initial diagnosis (M1), distant metastasis during follow‐up (M2), and no evidence of distant metastasis over the course of the study (M0). Data were collected and summarized on clinical data, laboratory parameters, imaging features, postoperative pathologic subtypes, and metastases. The Cox proportional hazard model was used to perform the univariate and multivariate analysis. Kaplan–Meier curves were used to evaluate cancer‐specific survival (CSS).ResultsBased on metastasis, the patients were assigned into three groups, including 31 in the M1 group, 15 in the M2 group, and 107 in the M0 group. These individuals were followed up for an average of 5.9 years, and the group included 46 patients with distant metastasis (31 confirmed at diagnosis and 15 found during follow‐up). Univariate Cox regression analysis showed that age, Hashimoto's thyroiditis (HT), surgery method, postoperative adjuvant therapy, histologic subtype, nodule size, calcification, TSH, and distant metastasis all impacted prognosis. Multivariate Cox regression analysis suggested that histologic subtype (widely invasive; HR: 7.440; 95% CI: 3.083, 17.954; p < 0.001), nodule size (≥40 mm; HR: 8.622; 95% CI: 3.181, 23.369; p < 0.001) and distant metastasis (positive; HR: 6.727; 95% CI: 2.488, 18.186; p < 0.001) were independent risk factors affecting the prognosis of follicular thyroid cancer.ConclusionsHistologic subtype, nodule size, and distant metastasis are important risk factors for the prognosis of follicular thyroid cancer. Patients with metastatic follicular thyroid cancer have a poor prognosis, especially with metastasis at the time of initial diagnosis. As a result, this group of patients requires individualized treatment and closer follow‐up.

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New Insights on the Importance of the Extent of Vascular Invasion in Widely Invasive Follicular Thyroid Carcinoma

et al. 2023

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Background This study aimed to investigate the association between the extent of vascular invasion (VI) and the outcome of widely invasive follicular thyroid carcinoma (WI-FTC). Methods The records of 107 patients with WI-FTC confirmed by surgical specimens from January 2005 to December 2016 were retrospectively reviewed. Results Among the 107 patients with WI-FTC, those with a VI of \ 4 (n = 62) and C 4 (n = 45) had a 10 year cause-specific survival (CSS) rate of 97.7% and 89.4% (p = 0.008), respectively. Univariate analysis identified M1 (p = 0.001), and the number of VI of C 4 as significant negative prognostic factors for CSS. Multivariate analysis identified M1 (hazard ratio [HR] = 9.366) as independent negative prognostic factor for CSS. Among the 72 patients with M0 WI-FTC, those with a VI of \ 2 (n = 33) and C 2 (n = 39) had a 10-year distant metastasis-free survival (DMFS) rate of 96.8% and 56.8% (p = 0.001), respectively. Univariate analysis identified age C 55 years (p = 0.011), presence of VI, the number of VI of C 2, and resection margin status (p \ 0.001) as significant negative prognostic factors for DMFS. Multivariate analysis identified the number of VI C 2 (HR = 9.137), and resection margin status (HR = 5.853) as independent negative prognostic factors for DMFS. Conclusions It may be unnecessary that WI-FTC with curative resection margin status and a VI of \ 2, especially in capsular invasion only, routinely undergo completion thyroidectomy and postoperative ablation.

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Prognostic factors for follicular thyroid carcinoma: the importance of vascular invasion

Cited by 11 publications

References 22 publications

The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma

The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma

Prognosis and influencing factors of follicular thyroid cancer

New Insights on the Importance of the Extent of Vascular Invasion in Widely Invasive Follicular Thyroid Carcinoma

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