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Clinical Implication of World Health Organization Classification in Patients with Follicular Thyroid Carcinoma in South Korea: A Multicenter Cohort Study

Endocrinology and Metabolism 2020년 35권 3호 p.618 ~ 627
Jin Meihua, 김은숙, 김보현, 김희경, 이현승, 전민지, 김태영, 강호철, 김원배, 송영기, 김미진, 김원구,
소속 상세정보
 ( Jin Meihua ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김은숙 ( Kim Eun-Sook ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Internal Medicine
김보현 ( Kim Bo-Hyun ) - Pusan National University Hospital Department of Internal Medicine
김희경 ( Kim Hee-Kyung ) - Chonnam National University Medical School Department of Internal Medicine
이현승 ( Yi Hyon-Seung ) - Chungnam National University Hospital Department of Internal Medicine
전민지 ( Jeon Min-Ji ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김태영 ( Kim Tae-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
강호철 ( Kang Ho-Cheol ) - Chonnam National University Medical School Department of Internal Medicine
김원배 ( Kim Won-Bae ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
송영기 ( Shong Young-Kee ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김미진 ( Kim Mi-Jin ) - Pusan National University Hospital Department of Internal Medicine
김원구 ( Kim Won-Gu ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine

Abstract


Background: The study aimed to compare the prognostic value of the 4th edition of World Health Organization classification (WHO-2017) with the previous WHO classification (WHO-2004) for follicular thyroid carcinoma (FTC).

Methods: This multicenter retrospective cohort study included 318 patients with FTC from five tertiary centers who underwent thyroid surgery between 1996 and 2009. We evaluated the prognosis of patients with minimally invasive (MI), encapsulated angioinvasive (EA), and widely invasive (WI) FTC according to WHO-2017. Further, we evaluated the proportion of variation explained (PVE) and Harrell’s C-index to compare the predictability of disease-free survival (DFS) and disease-specific survival (DSS).

Results: In total, 227, 58, and 33 patients had MI-, EA-, and WI-FTC, respectively. During a median follow-up of 10.6 years, 46 (14.5%) patients had disease recurrence and 20 (6.3%) patients died from FTC. The 10-year DFS rates of patients with MI-, EA-, and WI-FTC were 91.1%, 78.2%, and 54.9%, respectively (P<0.001, PVE=7.1%, C-index=0.649). The corresponding 10-year DSS rates were 95.9%, 93.5%, and 73.5%, respectively (P<0.001, PVE=2.6%, C-index=0.624). The PVE and C-index values were higher using WHO-2017 than using WHO-2004 for the prediction of DFS, but not for DSS. In multivariate analysis, older age (P=0.02), gross extrathyroidal extension (ETE) (P=0.003), and distant metastasis (P<0.001) were independent risk factors for DSS.

Conclusion: WHO-2017 improves the predictability of DFS, but not DSS, in patients with FTC. Distant metastasis, gross ETE and older age (≥55 years) were independent risk factors for DSS.

키워드

Thyroid neoplasms; Adenocarcinoma, follicular; World Health Organization; Recurrence; Survival

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