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Tall cell and diffuse sclerosing variants of papillary thyroid cancer: outcome and predicting value of risk stratification methods

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Abstract

Purpose

Tall cell (TCV) and diffuse sclerosing (DSV) variants are aggressive variants of papillary thyroid cancer (PTC). We compared the risk of recurrent/persistent disease in patients with TCV, DSV and classical PTC (cPTC) and evaluated the prognostic accuracy of initial vs. ongoing risk stratification.

Methods

A consecutive series of DSV (n = 54), TCV (n = 72) and cPTC (n = 184) patients was retrospectively analyzed. TCV and DSV patients were first risk stratified for recurrent/persistent disease without considering the histotype as a risk factor and subsequently, 6–24 months after initial treatment, re-classified on the basis of the response to therapy (ongoing risk stratification).

Results

Extrathyroidal extension was more frequent in DSV than in TCV and cPTC patients (p < 0.05); moreover, only DSV tumors had a higher rate of recurrent/persistent disease when compared to cPTC treated with the same protocol (total thyroidectomy followed by 131I treatment) (p < 0.01). After initial treatment, 54.2% of TCV and 20.4% of DSV patients were classified at low risk, while at ongoing risk stratification, the excellent response (low risk) was higher for both TCV (77.8%) and DSV (50.0%) patients relative to initial stratification (both p < 0.01). Using ongoing risk classification, positive predictive value (PPV) for persistent/recurrent disease was higher relative to initial risk stratification for both TCV (PPV = 93.8 vs. 39.4%) and DSV (PPV = 63.0 vs. 34.9%), p < 0.05 for both.

Conclusions

In our series DSV, but not TCV patients, had poorer outcome than cPTC treated with the same protocol. Moreover, the ongoing risk stratification predicted outcome better than the initial classification in both TCV and DSV patients.

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Author notes

  1. M. Russo and P. Malandrino contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy

    M. Russo, M. Moleti, F. Vermiglio & M. A. Violi

  2. Endocrinology, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Via Palermo 636, 95122, Catania, Italy

    P. Malandrino, I. Marturano, E. Minaldi, R. Vigneri, G. Pellegriti & C. Regalbuto

  3. Institute of Biostructures and Bioimaging, CNR, Via P. Gaifami 18, 95126, Catania, Italy

    R. Vigneri

Authors
  1. M. Russo
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  2. P. Malandrino
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Correspondence to M. Russo.

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The authors declare that they have no conflict of interests.

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All procedures performed during this retrospective study were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of retrospective research formal consent is not required.

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Russo, M., Malandrino, P., Moleti, M. et al. Tall cell and diffuse sclerosing variants of papillary thyroid cancer: outcome and predicting value of risk stratification methods. J Endocrinol Invest 40, 1235–1241 (2017). https://doi.org/10.1007/s40618-017-0688-9

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  • DOI: https://doi.org/10.1007/s40618-017-0688-9

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