Endocrinol Metab.  2021 Jun;36(3):619-627. 10.3803/EnM.2021.974.

Clinicopathological Characteristics and Recurrence-Free Survival of Rare Variants of Papillary Thyroid Carcinomas in Korea: A Retrospective Study

• Kim M
• Cho SW
• Park YJ
• Ahn HY
• Kim HS
• Suh YJ
• Choi D
• Kim BK
• Yang GE
• Park IS
• Yi KH
• Jung CK
• Kim BH

• KMID: 2517652
• DOI: http://doi.org/10.3803/EnM.2021.974

Abstract

Background
We aimed to evaluate the clinicopathological features and biological behaviors of Korean thyroid cancer patients with rare variants of papillary thyroid carcinoma (PTC) to address the ambiguity regarding the prognostic consequences of these variants.
Methods
We retrospectively reviewed the medical records of 5,496 patients who underwent thyroid surgery for PTC, between January and December 2012, in nine tertiary hospitals. Rare PTC variants included tall cell (TCV), columnar cell (CCV), diffuse sclerosing (DSV), cribriform-morular (CMV), solid (SV), hobnail, and Warthin-like variants. Recurrence-free survival (RFS) was defined as the time from the date of thyroidectomy until recurrence.
Results
Rare variants accounted for 1.1% (n=63) of the PTC patients; with 0.9% TCV, 0.02% CCV, 0.1% DSV, 0.1% CMV, and 0.1% SV. The mean age of patients and primary tumor size were 42.1±13.1 years and 1.3±0.9 cm, respectively. Extrathyroidal extension and cervical lymph node metastasis were observed in 38 (60.3%) and 37 (58.7%) patients, respectively. Ultrasonographic findings revealed typical malignant features in most cases. During a median follow-up of 7 years, 6.3% of patients experienced a locoregional recurrence. The 5-year RFS rates were 71.4% in patients with DSV or SV, 95.9% for TCV, or CCV, and 100% for other variants. DSV emerged an independent risk factor associated with shorter RFS.
Conclusion
In this multicenter Korean cohort, rare variants accounted for 1.1% of all PTC cases, with TCV being the most frequent subtype. DSV emerged as a significant prognostic factor for RFS.

Keyword

Thyroid neoplasms; Carcinoma; papillary; Prognosis; Recurrence; Prevalence

Figure

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  Fig. 1 Forest plot for the overall pooled prevalence of rare variants of papillary thyroid carcinoma. The size of the box represents the weight given to each institution. The whiskers indicate the 95% confidence interval (CI).

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  Fig. 2 (A) Recurrence-free survival curves according to each pathological variant. (B) Recurrence-free survival curves according to the American Thyroid Association classification: variants with aggressive outcomes include tall cell (TCV), columnar cell (CCV), and hobnail variants; those with less favorable outcomes include solid (SV) and diffuse sclerosing variants (DSV); and those with favorable outcomes include cribriform-morular (CMV), and Warthin-like variants.

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  Fig. 3 Recurrence-free survival curves of patients with diffuse sclerosing variant (DSV) and others.

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