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GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME

Medullary thyroid carcinoma (MTC) is a rare non-follicular cell-derived tumor. A robust grading system may help better stratify patients at risk for recurrence and death from disease. One hundred forty-four MTC between 1988 and 2018 were subjected to a detailed histopathologic evaluation. Clinical a...

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Autores principales: Alzumaili, Bayan, Xu, Bin, Spanheimer, Philip M., Tuttle, R Michael, Sherman, Eric, Katabi, Nora, Dogan, Snjezana, Ganly, Ian, Untch, Brian R., Ghossein, Ronald A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483270/
https://www.ncbi.nlm.nih.gov/pubmed/32313184
http://dx.doi.org/10.1038/s41379-020-0532-1
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author Alzumaili, Bayan
Xu, Bin
Spanheimer, Philip M.
Tuttle, R Michael
Sherman, Eric
Katabi, Nora
Dogan, Snjezana
Ganly, Ian
Untch, Brian R.
Ghossein, Ronald A.
author_facet Alzumaili, Bayan
Xu, Bin
Spanheimer, Philip M.
Tuttle, R Michael
Sherman, Eric
Katabi, Nora
Dogan, Snjezana
Ganly, Ian
Untch, Brian R.
Ghossein, Ronald A.
author_sort Alzumaili, Bayan
collection PubMed
description Medullary thyroid carcinoma (MTC) is a rare non-follicular cell-derived tumor. A robust grading system may help better stratify patients at risk for recurrence and death from disease. One hundred forty-four MTC between 1988 and 2018 were subjected to a detailed histopathologic evaluation. Clinical and pathologic data were correlated with disease specific survival (DSS), local recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Median age was 53 years (range: 3–88). Median tumor size was 1.8 cm (range: 0.2–11). Lymph node metastases were present in 84 (58%) cases while distant metastases at presentation were found in 9 (6%) patients. Seven (5%) had ≥5 mitoses/10 HPFs. Tumor necrosis was present in 30 cases (20%) while lymphovascular invasion occurred in 41 (28%) of tumors. Extra-thyroidal extension was found in 44 (31%) and positive margins were seen in 19 (14%). There was a strong correlation between increasing tumor size and tumor necrosis (p<0.001). Median follow up was 39 months. In univariate analysis, male gender, higher AJCC stage group, larger tumor size, tumor necrosis, high mitotic index (≥5/10 HPF), nodal status, size of largest nodal metastasis, and elevated post-operative serum calcitonin predicted worse DSS, LRFS and DMFS (p<0.05). Extra-thyroidal extension correlated with DSS and DMFS while positive margins and distant metastasis at presentation imparted worse DSS (p<0.05). In multivariate analysis, tumor necrosis and mitotic activity (5 mitosis/10 HPFs as the cutoff) were the only independent predictors for DSS (p=0.008 and 0.026 respectively). Tumor necrosis was the sole independent prognostic factor for LRFS and DMFS (p=0.001 and 0.003 respectively). The presence of tumor necrosis and high mitotic rate are powerful independent prognostic factors in MTC and outperform serum calcitonin and stage. We propose a grading system based on tumor necrosis and mitotic activity to better stratify MTC patients for counseling, post resection surveillance and therapy.
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spelling pubmed-74832702020-10-20 GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME Alzumaili, Bayan Xu, Bin Spanheimer, Philip M. Tuttle, R Michael Sherman, Eric Katabi, Nora Dogan, Snjezana Ganly, Ian Untch, Brian R. Ghossein, Ronald A. Mod Pathol Article Medullary thyroid carcinoma (MTC) is a rare non-follicular cell-derived tumor. A robust grading system may help better stratify patients at risk for recurrence and death from disease. One hundred forty-four MTC between 1988 and 2018 were subjected to a detailed histopathologic evaluation. Clinical and pathologic data were correlated with disease specific survival (DSS), local recurrence free survival (LRFS) and distant metastasis free survival (DMFS). Median age was 53 years (range: 3–88). Median tumor size was 1.8 cm (range: 0.2–11). Lymph node metastases were present in 84 (58%) cases while distant metastases at presentation were found in 9 (6%) patients. Seven (5%) had ≥5 mitoses/10 HPFs. Tumor necrosis was present in 30 cases (20%) while lymphovascular invasion occurred in 41 (28%) of tumors. Extra-thyroidal extension was found in 44 (31%) and positive margins were seen in 19 (14%). There was a strong correlation between increasing tumor size and tumor necrosis (p<0.001). Median follow up was 39 months. In univariate analysis, male gender, higher AJCC stage group, larger tumor size, tumor necrosis, high mitotic index (≥5/10 HPF), nodal status, size of largest nodal metastasis, and elevated post-operative serum calcitonin predicted worse DSS, LRFS and DMFS (p<0.05). Extra-thyroidal extension correlated with DSS and DMFS while positive margins and distant metastasis at presentation imparted worse DSS (p<0.05). In multivariate analysis, tumor necrosis and mitotic activity (5 mitosis/10 HPFs as the cutoff) were the only independent predictors for DSS (p=0.008 and 0.026 respectively). Tumor necrosis was the sole independent prognostic factor for LRFS and DMFS (p=0.001 and 0.003 respectively). The presence of tumor necrosis and high mitotic rate are powerful independent prognostic factors in MTC and outperform serum calcitonin and stage. We propose a grading system based on tumor necrosis and mitotic activity to better stratify MTC patients for counseling, post resection surveillance and therapy. 2020-04-20 2020-09 /pmc/articles/PMC7483270/ /pubmed/32313184 http://dx.doi.org/10.1038/s41379-020-0532-1 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Alzumaili, Bayan
Xu, Bin
Spanheimer, Philip M.
Tuttle, R Michael
Sherman, Eric
Katabi, Nora
Dogan, Snjezana
Ganly, Ian
Untch, Brian R.
Ghossein, Ronald A.
GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title_full GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title_fullStr GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title_full_unstemmed GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title_short GRADING OF MEDULLARY THYROID CARCINOMA ON THE BASIS OF TUMOR NECROSIS AND HIGH MITOTIC RATE IS AN INDEPENDENT PREDICTOR OF POOR OUTCOME
title_sort grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483270/
https://www.ncbi.nlm.nih.gov/pubmed/32313184
http://dx.doi.org/10.1038/s41379-020-0532-1
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