Abstract
Background
Completion total thyroidectomy with radioactive iodine (RAI) therapy is not uniformly recommended for minimally invasive follicular thyroid carcinomas (MI-FTCs) without distant metastasis, but may be considered for cases with a risk factor of recurrence, such as age ≥ 45 years.
Objective
The present study aimed to investigate the outcomes for patients with MI-FTC using a stratification age of 55 years.
Methods
The records of 478 patients with MI-FTC confirmed by surgical specimens at Ito Hospital from January 2005 to December 2014 were retrospectively reviewed. Twenty patients had distant metastasis at diagnosis and were subsequently classified as M1.
Results
Among the 478 patients with MI-FTC, univariate analysis identified that age ≥ 55 years (p = 0.002) and M1 (p < 0.001) were related to cause-specific survival. In 458 patients with M0 MI-FTC, male sex (p = 0.041), age ≥ 55 years (p = 0.001), and tumor size > 40 mm (p < 0.001) were related to poor disease-free survival (DFS) in univariate analysis. Multivariate analysis showed that age ≥ 55 years (p = 0.005) and tumor size > 40 mm (p = 0.005) were independent prognostic factors for DFS. The 10-year DFS rates of patients aged < 45 years, 45 years ≤ age < 55 years, and ≥ 55 years were 97.0%, 95.5%, and 86.4%, respectively.
Conclusions
The change in the recommended age for completion total thyroidectomy with RAI, from 45 to 55 years, seemed reasonable.
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References
Dralle H, Machens A, Basa J, et al. Follicular cell-derived thyroid cancer. Nat Rev Dis Primers. 2015;1:15077.
Lloyd RV, Osamura RY, Klöppel G, Rosai J (eds). WHO Classification of Tumours of Endocrine Organs (4th edition). Lyon: IARC; 2017.
Podda M, Saba A, Porru F, Reccia I, Pisanu A. Follicular thyroid carcinoma: differences in clinical relevance between minimally invasive and widely invasive tumors. World J Surg Oncol. 2015;4;13:193.
DeLellis RA, Lloyd RV, Heitz PU, Eng C. Tumours of Endocrine Organs, World Health Organization Classification of Tumours: Pathology and Genetics. Lyon: IARC;2004.
D’Avanzo A, Treseler P, Ituarte PH, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer. 2004;100(6):1123–9.
O’Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS. Management of follicular thyroid carcinoma should be individualized based on degree of capsular and vascular invasion. Eur J Surg Oncol. 2011;37(2):181–5.
Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr J. 2020;67(7):669–717.
Sugino K, Kameyama K, Ito K, et al. Outcomes and prognostic factors of 251 patients with minimally invasive follicular thyroid carcinoma. Thyroid. 2012;22(8):798–804.
Sugino K, Kameyama K, Nagahama M, et al. Does completion thyroidectomy improve the outcome of patients with minimally invasive follicular carcinoma of the thyroid? Ann Surg Oncol. 2014;21(9):2981-6.
Shaha AR, Migliacci JC, Nixon IJ, et al. Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer. Surgery. 2019;165(1):6–11.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.
Park SH, Goo JM, Jo CH. Receiver operating characteristic (ROC) curve: practical review for radiologists. Korean J Radiol 2004;5(1):11–8.
Robinson A, Schneider D, Sippel R, Chen. Minimally invasive follicular thyroid cancer: treat as a benign or malignant lesion? J Surg Res 2017;207:235–40.
Stenson G, Nilsson IL, Mu N, et al. Minimally invasive follicular thyroid carcinomas: prognostic factors. Endocrine 2016;53(2):505–11.
Ito Y, Hirokawa M, Masuoka H, et al. Prognostic factors of minimally invasive follicular thyroid carcinoma: extensive vascular invasion significantly affects patient prognosis. Endocr J. 2013;60(5):637–42.
Xu B, Wang L, Tuttle RM, Ganly I, Ghossein R. Prognostic impact of extent of vascular invasion in low-grade encapsulated follicular cell-derived thyroid carcinomas: a clinicopathologic study of 276 cases. Hum Pathol. 2015;46(12):1789–98.
Daniels GH. Follicular thyroid carcinoma: a perspective. Thyroid. 2018;28(10):1229–42.
Nixon IJ, Wang LY, Migliacci JC, et al. An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid. 2016;26(3):373–80.
Haugen BR, Alexander EK, Bible KC, et al. 2015 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;26:1–133.
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The authors thank Enago (https://www.enago.jp/) for editing this manuscript.
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Haruhiko Yamazaki, Kiminori Sugino, Ryohei Katoh, Kenichi Matsuzu, Chie Masaki, Junko Akaishi, Kiyomi Yamada Hames, Chisato Tomoda, Akifumi Suzuki, Keiko Ohkuwa, Wataru Kitagawa, Mitsuji Nagahama, Munetaka Masuda, and Koichi Ito have no disclosures to declare.
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Yamazaki, H., Sugino, K., Katoh, R. et al. Outcomes for Minimally Invasive Follicular Thyroid Carcinoma in Relation to the Change in Age Stratification in the AJCC 8th Edition. Ann Surg Oncol 28, 3576–3583 (2021). https://doi.org/10.1245/s10434-020-09397-3
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DOI: https://doi.org/10.1245/s10434-020-09397-3