Session: CSEM RESIDENT CLINICAL VIGNETTES - SERIES II
(CSEMP027) NATURAL HISTORY AND PROGNOSTIC MARKERS OF AGGRESSIVE SUBTYPES AND HIGH-GRADE FOLLICULAR CELL-DERIVED MALIGNANCIES: A RETROSPECTIVE CHART REVIEW STUDY
Saturday, October 28, 2023
16:30 – 17:30 EST
Location: 516AB
Disclosure(s):
Mazin M. Almaghrabi: No financial relationships to disclose
Abstract:
Background: The prevalence of thyroid cancer has increased significantly. Aggressive subtypes of papillary thyroid cancer (AG-PTC) and poorly differentiated thyroid cancer (PDTC) are malignancies that lie between well-differentiated and undifferentiated cancers. The management of well-differentiated cancers has been established in the literature; however, that of AG-PTC and PDTC needs to be clarified because they exhibit characteristics different from those of their less aggressive counterparts.
Objective: To describe the clinicopathological characteristics and genomic landscape of AG-PTC and PDTC and to assess their prognostic value
Design: A retrospective chart review of patients with thyroid cancer over the last 10 years
Setting: Single center
Participants: Patients with AG-PTC or PDTC were included in the analysis. Patients with other types of thyroid cancer were excluded. The clinical presentation, pathological characteristics, molecular markers, specific treatments, and clinical outcomes were compared between the groups.
Results: Of the 3,244 thyroid cancer charts reviewed, 136 met the criteria for AG-PTC and PDTC. The mean age at diagnosis was 49 years, with a predominance of women. The median follow-up duration was 3 years (0.1–30). Of 75 patients followed up for >1 year, 42.7% had either a persistent or recurrent disease (52.6% in the AG-PTC group and 32.4% in the high-grade follicular cell-derived malignancy group), 4.5% died of AG-PTC, and 1.8% had PDTC. The presence of vascular or lymphovascular invasion and extrathyroidal extension was associated with a higher incidence of persistent or recurrent disease (Hazard ratio: 2.5, 3.8, and 4.2, respectively; p < 0.05). No difference was observed in recurrence based on the presence of BRAF mutations or the percentage of aggressive/poorly differentiated tumor involvement.
Conclusions and Relevance: Possible prognostic markers for predicting recurrent and persistent thyroid cancers and guiding therapy for AV-PTC and PTC include vascular/lymphovascular invasion, extrathyroidal extension, response to primary therapy, and the proliferative index Ki-67.
