高细胞亚型甲状腺乳头状癌的侵袭性组织病理学特征研究

doi:10.16139/j.1007-9610.2023.06.07

摘要/Abstract

摘要：

目的: 探索研究高细胞亚型(tall cell variant, TCV)甲状腺乳头状癌(papillary thyroid carcinoma, PTC)的侵袭性组织病理学特征。方法: 回顾性分析2018年1月至2023年5月上海交通大学医学院附属瑞金医院19 170例PTC病例，分析比较TCV-PTC组和经典型PTC(classic PTC, cPTC)组的临床病理学特征。结果: 病理结果显示TCV-PTC组1 380例，cPTC组15 578例。TCV-PTC在病人年龄以及肿瘤腺外侵犯、神经侵犯、脉管侵犯、癌灶最大径、多灶癌、中央区和颈侧区淋巴结转移和BRAF基因突变比例和（或）均值均较高，但合并桥本甲状腺炎的比例少于cPTC，差异有统计学意义（P<0.05）。结论: TCV-PTC与cPTC相比，局部侵袭性特征较强和淋巴结转移率较高，该病理类型的判定为后续更积极的临床治疗选择提供依据。

关键词: 甲状腺乳头状癌, 高细胞亚型, 病理学特征, 肿瘤侵袭和转移

Abstract:

Objective To study the invasive histopathological features of papillary thyroid carcinoma(PTC) with tall cell variant(TCV). Methods A retrospective analysis of 19 170 cases of PTC in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to May 2023 was performed to analyze and the clinicopathological features between TCV-PTC group and classic PTC (cPTC) group. Results Pathological results showed 1 380 cases in TCV-PTC group and 15 578 cases in cPTC group. TCV-PTC had higher proportion and (or) mean value in patients' age, extraglandular invasion, nerve invasion, vascular invasion, maximum diameter of cancer focus, multifocality，lymph node metastasis and BRAF mutation, but the proportion of patients with coexistent Hashimoto's thyroiditis was lower than cPTC， and all results had significant difference (P<0.05). Conclusions Compared with the cPTC, TCV-PTC has stronger local invasive characteristics and lymph node metastasis rate, which provides the basis for the subsequent clinical treatment.

Key words: Papillary thyroid carcinoma, Tall cell variant, Histopathological feature, Tumor invasion and metastasis

中图分类号:

R736.1

廖振宇, 赵起悟, 匡洁, 刘卓然, 孙寒星, 王越, 邱伟华, 陈曦, 严佶祺. 高细胞亚型甲状腺乳头状癌的侵袭性组织病理学特征研究[J]. 外科理论与实践, 2023, 28(06): 524-528.

LIAO Zhenyu, ZHAO Qiwu, KUANG Jie, LIU Zhuoran, SUN Hanxing, WANG Yue, QIU Weihua, CHEN Xi, YAN Jiqi. Study on invasive histopathological features of papillary thyroid carcinoma with tall cell variant[J]. Journal of Surgery Concepts & Practice, 2023, 28(06): 524-528.

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Histological classification	Number
Classic PTC	15 578(81.26)
Follicular variant	1 906(9.94)
Tall cell variant	1 380(7.20)
Diffuse Sclerosing	414(2.16)
Warthin-like	65(0.34)
Solid/trabecular variant	63(0.33)
Hobnail variant	36(0.19)
Oncocytic variant	20(0.10)
Columnar cell variant	5(0.03)
Encapsulated variant	5(0.03)

Item	cPTC （n=15 578）	TCV-PTC （n=1 380）	t/χ² value	P value
Age	42.1±11.8	44.3±12.3	6.62	<0.001
Gender [n(%)]
Female	11 545(74.1)	1 027(74.4)	0.06	0.801
Male	4 033(25.9)	353(25.6)
Original surgical approach [n(%)]
Hemithyroidectomy and selective neck dissection	11 507(73.9)	932(67.5)	25.99	<0.001
Total thyroidectomy	4 071(26.1)	448(32.5)
Radical neck dissection [n(%)]
Yes	1 247(8.0)	197(14.3)	63.98	0.001
No	14 331(92.0)	1 183(85.7)

Item	cPTC （n=15 578）	TCV-PTC （n=1 380）	t/χ² value	P value
Extrathyroidal extension [n(%)]
Yes	6 012(38.6)	1 140(82.6)	1 007	<0.001
No	9 566(61.4)	240(17.4)
Nerve invasion [n(%)]
Yes	87(0.6)	32(2.3)	56.38	<0.001
No	15 491(99.4)	1 348 (97.7)
Lymphovascular invasion [n(%)]
Yes	49(0.3)	16(1.2)	23.70	<0.001
No	15 529(99.7)	1364(98.8)
Multifocality [n(%)]
Yes	3 401(21.8)	356(25.8)	11.56	0.001
No	12 177(78.2)	1024(74.2)
Maximal tumor diameter （cm）	0.77±0.58	1.29±0.72	31.24	<0.001
Lymph node positivity [n(%)]
Yes	6 571(42.2)	742(53.8)	69.39	<0.001
No	9 007(57.8)	638(46.2)
BRAF mutation [n(%)]
Yes	6 451(79.2)	892(93.6)	113.6	<0.001
No	1 694(20.8)	61(6.4)
Combined Hashimoto thyroiditis [n(%)]
Yes	2 118(13.6)	144(10.4)	10.96	<0.001
No	13 460(86.4)	1236(89.6)

Item	cPTC （n=15 578）	TCV-PTC （n=1 380）	t/Z/χ² value	P value
Central lymph nodes positivity [n(%)]
Yes	6 389(41.0)	719(52.1)	64.02	<0.001
No	9 189(59.0)	661(47.9)
Maximum diameter of central lymph nodes metastasis (mm)	2.90±2.46	3.34±2.89	3.14	0.002
The number of positive central lymph nodes	2.93±2.66	3.32±3.03	-3.34	0.001
Lateral neck lymph nodes positivity [n(%)]
Yes	1 092(7.0)	175(12.7)	58.98	<0.001
No	14 486(93.0)	1 205(87.3)
Maximum diameter of lateral neck lymph nodes metastasis (mm)	7.84±5.40	9.06±6.05	1.85	0.065
The number of positive lateral neck lymph nodes	4.24±3.56	4.95±3.78	-2.56	0.010
Bilateral neck lymph nodes positivity [n(%)]
Yes	56(0.4)	9(0.7)	2.85	0.092
No	15 522(99.6)	1 371(99.3)