Soft tissue invasion of papillary thyroid carcinoma

Abstract

Extrathyroidal extension (ETE) of papillary thyroid carcinoma (PTC) is common and clinical presentation can vary from minimal to extensive locoregional involvement. Although PTC is generally considered the most benign among all thyroid carcinomas, it may present with local invasion with poor prognosis. Our retrospective study involved 3267 PTC patients undergoing regular follow-up at Chang Gung Medical Center in Linkou, Taiwan. Among them, 269 were PTC cases with ETE, having tumors greater than 1 cm in size and treated with total or complete thyroidectomy with or without lymph node dissection for which the follow-up period was over 10 years. The mean age of 269 cases was 46.8 ± 15.1 (range 11–83 years) years. The number of females was 204 (75.8 %). Patients were categorized into minimal ETE (175 cases) and extensive ETE (94 cases) groups according to surgical findings and pathological reports. Mean follow-up period was 13.3 ± 5.5 (range 0.2–29.3) years, during which 28 (10.4 %) patients died of thyroid cancer; and 63 (23.4 %) of all-cause mortality. Multivariate analysis showed that age, gender, extensive ETE, and lymph node metastasis had a statistically significant effect on thyroid cancer mortality. Survival rates were significantly different between minimal ETE and extensive ETE groups (p < 0.0001). In conclusion, perithyroidal soft tissue involvement by PTC is an important factor that determines patient prognosis and a closer follow-up and more aggressive treatment is necessary for patients who are old, male, extensive ETE, and with lymph node involvement.

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“…Lin et al found that patients with ETE demonstrated a lower survival rate than those with intrathyroidal and lymph node metastases. They reported that the mortality rates in patients with extensive ETE and secondary primary malignancy increased to 71.4% (33.3% in those without ETE) 25 . However, this study did not divide the ETE into subgroups.…”

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“…Tumor metastasis is the major cause of cancer-related deaths [ 5 ]. The development of cancer metastasis involves multiple steps.…”

Taraxasterol inhibits TGF-β1-induced epithelial-to-mesenchymal transition in papillary thyroid cancer cells through regulating the Wnt/β-catenin signaling

“…31 Its tendency to metastasis is responsible for poor prognosis of PTC patients and is also an important reason for the majority of patient deaths. 11,12 Numerous studies have demonstrated that EMT is a crucial process during cancer progression and metastasis and could be promoted through multiple signaling pathways in cancer cells. 32,33 Thus, exploration of novel agents targeting EMT-associated pathways is urgently needed for PTC treatment.…”

“…8–10 Unfortunately, there still are a small fraction of patients who develop local and distant metastasis and consequently suffer from a low survival rate. 11,12 Therefore, it is desperately needed to have a better understanding of the mechanisms underlying PTC metastasis.…”