Unexpected high-risk pathologic features following thyroidectomy in the chinese immigrant population

Area of Science:

• Oncology
• Surgical Pathology
• Epidemiology

Background:

• Papillary thyroid cancer is the most common endocrine malignancy.
• Accurate risk stratification is crucial for optimal patient management.
• Pathologic features like extrathyroidal extension impact prognosis and treatment decisions.

Purpose of the Study:

• To compare the incidence of unexpected high-risk pathologic features in Chinese versus non-Asian patients who underwent thyroidectomy for papillary thyroid cancer.
• To identify demographic or tumor-related factors associated with these features.

Main Methods:

• Retrospective cohort study including 179 patients (58 Chinese, 121 non-Asian) who underwent thyroidectomy for papillary thyroid cancer (2015-2017).
• Analysis of patient demographics, tumor characteristics, and histopathology, focusing on lymphovascular invasion (LVI) and microscopic extrathyroidal extension (mETE).
• Multivariate logistic regression and propensity score-weighted analyses were used to compare outcomes between groups.

Main Results:

• No significant differences were observed in rates of LVI, multifocality, or extent of surgery between Chinese and non-Asian cohorts.
• Patients with mETE were more likely to have larger tumors.
• Chinese ancestry was independently associated with a significantly increased rate of unexpected mETE (adjusted prevalence ratio, 2.52).

Conclusions:

• The prevalence of unexpected microscopic extrathyroidal extension (mETE) is significantly higher in immigrant Chinese patients compared to non-Asian populations.
• This increased risk associated with mETE in Chinese patients warrants consideration during the initial surgical planning phase for papillary thyroid cancer.