Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants

Xiaoguang Shi, Rengyun Liu, Fulvio Basolo, Riccardo Giannini, Xiaopei Shen, Di Teng, Haixia Guan, Zhongyan Shan, Weiping Teng, Thomas J. Musholt, Khawla Al-Kuraya, Laura Fugazzola, Carla Colombo, Electron Kebebew, Barbara Jarzab, Agnieszka Czarniecka, Bela Bendlova, Vlasta Sykorova, Manuel Sobrinho-Simães, Paula SoaresYoung Kee Shong, Tae Yong Kim, Sonia Cheng, Sylvia L. Asa, David Viola, Rossella Elisei, Linwah Yip, Caterina Mian, Federica Vianello, Yangang Wang, Shihua Zhao, Gisele Oler, Janete M. Cerutti, Efisio Puxeddu, Shen Qu, Qing Wei, Huixiong Xu, Christine J. O'Neill, Mark S. Sywak, Roderick Clifton-Bligh, Alfred K. Lam, Garcilaso Riesco-Eizaguirre, Pilar Santisteban, Hongyu Yu, Giovanni Tallini, Elizabeth H. Holt, Vasily Vasko, Mingzhao Xing

Research output: Contribution to journalArticlepeer-review

125 Scopus citations


Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data demonstrating differential risks of PTC variants to support. Objective: This study sought to establish the differential clinicopathological risk of major PTC variants: conventional PTC (CPTC), follicular-variant PTC (FVPTC), and tall-cell PTC (TCPTC). Methods: Thiswasa retrospective study of clinicopathological outcomes of 6282 PTC patients (4799 females and 1483 males) from 26 centers and The Cancer Genome Atlas in 14 countries with a median age of 44 years (interquartile range, 33â€"56 y) and median follow-up time of 37 months (interquartile range, 15â€"82 mo). Results: The cohort consisted of 4702 (74.8%) patients with CPTC, 1126 (17.9%) with FVPTC, and 239 (3.8%) with TCPTC. The prevalence of high-risk parameters was significantly different among the three variants, including extrathyroidal invasion, lymph node metastasis, stages III/IV, disease recurrence, mortality, and the use (need) of radioiodine treatment (all P > .001), being highest in TCPTC, lowest in FVPTC, and intermediate in CPTC, following an order of TCPTC>CPTC蠑FVPTC. Recurrence and mortality in TCPTC, CPTC, and FVPTC were 27.3 and 6.7%, 16.1 and 2.5%, and 9.1 and 0.6%, corresponding to events per 1000 person-years (95% confidence interval [CI]) of 92.47 (64.66â€"132.26) and 24.61 (12.31â€" 49.21), 34.46 (30.71â€"38.66), and 5.87 (4.37â€"7.88), and 24.73 (18.34 â€"33.35) and 1.68 (0.54 â€"5.21), respectively. Mortality hazard ratios of CPTC and TCPTC over FVPTC were 3.44 (95% CI, 1.07â€"11.11) and 14.96 (95% CI, 3.93â€"56.89), respectively. Kaplan-Meier survival analyses showed the best prognosis in FVPTC, worst in TCPTC, and intermediate in CPTC in disease recurrence-free probability and disease-specific patient survival. This was particularly the case in patients at least 45 years old. Conclusion: This large multicenter study demonstrates differential prognostic risks of the three major PTC variants and establishes a unique risk order of TCPTC > CPTC 蠑 FVPTC, providing important clinical implications for specific variant-based management of PTC.

Original languageEnglish (US)
Pages (from-to)264-274
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Issue number1
StatePublished - Jan 2016

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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