Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort

Domínguez, José M.; Nilo, Flavia; Martínez, María T.; Massardo, José M.; Muñoz, Sueli; Contreras, Tania; Carmona, Rocío; Jerez, Joaquín; González, Hernán; Droppelmann, Nicolás; León, Augusto

doi:10.20945/2359-3997000000013

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Archives of Endocrinology and Metabolism

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Sumário

Original Article • Arch. Endocrinol. Metab. 62 (1) • Jan-Feb 2018 • https://doi.org/10.20945/2359-3997000000013 copy

Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

We aimed to describe the presentation of papillary microcarcinoma (PTMC) and identify the clinical and histological features associated with persistence/recurrence in a Latin American cohort.

Subjects and methods

Retrospective study of PTMC patients who underwent total thyroidectomy, with or without radioactive iodine (RAI), and who were followed for at least 2 years. Risk of recurrence was estimated with ATA 2009 and 2015 classifications, and risk of mortality with 7^th and 8^th AJCC/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence.

Results

We included 209 patients, predominantly female (90%), 44.5 ± 12.6 years old, 183 (88%) received RAI (90.4 ± 44.2 mCi), followed-up for a median of 4.4 years (range 2.0–7.8). The 7^th and 8^th AJCC/TNM system classified 89% and 95.2% of the patients as stage I, respectively. ATA 2009 and ATA 2015 classified 70.8% and 78.5% of the patients as low risk, respectively. Fifteen (7%) patients had persistence/recurrence during follow-up. In multivariate analysis, only lymph node metastasis was associated with persistence/recurrence (coefficient beta 4.0, p = 0.016; 95% CI 1.3-12.9). There were no PTMC related deaths.

Conclusions

Our series found no mortality and low rate of persistence/recurrence associated with PTMC. Lymph node metastasis was the only feature associated with recurrence in multivariate analysis. The updated ATA 2015 and 8^th AJCC/TNM systems classified more PTMCs than previous classifications as low risk of recurrence and mortality, respectively.

Keywords
Thyroid cancer; head and neck; endocrine

		Total Cohort (N = 209)	Persistence/Recurrence		P-value
		Total Cohort (N = 209)	No (n = 194)	Yes (n = 15)	P-value
Age at diagnosis (years)		44.5 ± 12.6	44.7 ± 12.8	40.8 ± 9.4	0.08
Female gender		188 (90%)	173 (89.1%)	15 (100%)	0,18
Histological subtype of PTC					0.6
	Classical variant	163 (78%)	150 (77.3%)	13 (87.0%)
	Follicular variant	36 (17.2%)	34 (17.7%)	2 (13.0%)
	Other variants	10 (4.8%)	10 (5.130%)	0 (0%)
Tumor diameter (cm)		0.62 ± 0.25	0,62 ± 0.26	0.65 ± 0.25	0.75
Sum of diameters (cm)		0.83 ± 0.54	0.83 ± 0.55	0.9 ± 0.48	0.9
Sum of all foci diameters > 2 cm		10 (4.8%)	10 (5.1%)	0 (0%)	0.36
Unifocal disease		128 (61.2%)	121 (62.4%)	7 (47.0%)	0.3.
Three or more foci		35 (16.7%)	30 (15.5%)	5 (33.3%)	0.07
Bilateral disease		50 (23.9%)	46 (23.7%)	4 (26.7%)	0.80
Minimal extra thyroidal extension		37 (17.7%)	31 (16.0%)	6 (40.0%)	0.019
Lymphocytic thyroiditis		88 (42.1%)	83 (42.8%)	5 (33.3%)	0.37
T					0.33
	1a	172 (82.3%)	154 (82.8%)	8 (61.5%)
	3	37 (17.7%)	32 (17.2%)	5 (38.5%)
N^* * N0 includes patients subjected to lymph node dissection whose biopsy found no tumor, and in whom physical exam, preoperative ultrasound and intraoperative evaluation found no evidence of lymph node metastases.					0.001
	0	174 (83.3%)	166 (86.0%)	8 (53.3%)
	1	35 (16.7%)	28 (14.0%)	7 (46.7%)
RAI ablation		183 (88.0%)	168 (86.6%)	15 (100%)	0.40
RAI dose (mCi)		90.4 ± 44.2	88.2 ± 44.2	116.7 ± 36.2	0.69
Length of follow-up (years)		4.4 (2.0-7.8)	4.4 (2.0 – 7.8)	4.2 (2.1 – 6.3)	0.37
AJCC 7^th
	I	186 (89%)	173 (89.2%)	13 (86.6%)	0.06
	III	21 (10%)	20 (10.3%)	1 (6.7%)
	IVA	2 (1.0%)	1 (0.5%)	1 (6.7%)
AJCC 8^th					0.34
	I	199 (95.2%)	184 (95.0%)	15 (100%)
	II	10 (4.8%)	10 (5.0%)	0 (0%)
ATA 2009					0.006
	Low	148 (70.8%)	142 (73.2%)	6 (40%)
	Intermediate	61 (29.2%)	52 (26.8%)	9 (60%)
ATA 2015					0.002
	Low	164 (78.5%)	157 (81%)	7 (46.7%)
	Intermediate	45 (21.5%)	37 (19%)	8 (53.3%)

Patient number	ATA 2015	Type of persistence/recurrence	Time between initial treatment and to persistence/recurrence (years)	Preoperative neck ultrasound done	Serum Tg (ng/mL)		Follow-up neck US	FNA	Therapy	2^nd Gen Tg (ng/mL)	Length of follow-up (years)	Status at end of follow-up
Patient number	ATA 2015	Type of persistence/recurrence		Preoperative neck ultrasound done	Suppressed	Stimulated	Follow-up neck US	FNA	Therapy	2^nd Gen Tg (ng/mL)	Length of follow-up (years)	Status at end of follow-up
1837	Low	Structural	0.8	No	< 0.9	NA	(+)	(+)	Sx	< 0.1	6.8	NED
1897	Low	Structural	2.2	No	3.6	NA	(+)	(+)	Sx + RAI	< 0.1	6.7	NED
2015	Intermediate	Structural	1.4	No	10.6	NA	(+)	NA	RAI	0.7	3.9	Biochemical disease
1952	Low	Structural	0.9	No	3.4	NA	(+)	(+)	Sx + RAI	< 0.1	6.1	NED
1997	Low	Structural	5.81	No	0.1	3.2	(-)	Chest CT and Dx scan compatible with 1.7 cm pulmonary metastasis	Sx + RAI	0.1	6.5	NED
1511	Low	Structural	1.2	No	5.5	NA	(+)	(+)	Sx + RAI	< 0.1	7.5	NED
1732	Intermediate	Structural	1.0	No	1.2	33	(+)	(+)	Sx + RAI	6.5	0.2	NED
2172	Intermediate	Structural	0.6	No	5.0	NA	(+)	(+)	Sx	4.8	<0.1	NED
2174	Intermediate	Structural	0.7	No	3.8	21	(+)	(+)	Sx	5.0	0.2	NED
2315	Low	Structural	1.96	Negative	< 0.9	NA	(+)	(+)	AS	0.2	4.5	Neck US non-specific nodule (granuloma) + negative chest CT
2232	Intermediate	Structural	4.0	No	< 0.9	NA	1 cm suspicious lateral cervical lymph node	Not done	AS	< 0.1	4.9	Stable neck US
2296	Intermediate	Structural	1.8	Cervical lymph nodes (+)	1.0	1.8	(+)	(+)	Sx + RAI	< 0.1	4.3	NED
1506	Low	Biochemical	0.9	Negative	2.4	27.1	(-)	(-)	AS	1.0	6.9	Biochemical disease (negative neck US and ¹⁸FDG PET- CT)
1520	Intermediate	Biochemical	2.4	Cervical lymph nodes (+)	< 0.9	2.8	(-)	NA	AS	< 0.1	7.5	NED
2195	Intermediate	Biochemical	1.1	Negative	< 0.9	2.7	(-)	NA	AS	0.2	4.8	NED Neck US + Chest CT negative

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[1] Correspondence to: José M. Domínguez, Diagonal Paraguay 362, 4^th floor, Santiago, Región Metropolitana, Chile jdomingu@uc.cl