Risk Factors Associated With Recurrence and Death in Patients With Tall Cell Papillary Thyroid Cancer: A...

Area of Science:

• Endocrinology
• Oncology
• Pathology

Background:

• Tall cell morphology (TCM) is a rare, aggressive variant of papillary thyroid carcinoma (PTC).
• TCM is associated with poorer patient outcomes, but prognostic factors are not well understood.
• Identifying these factors is crucial for tailoring treatment and improving survival rates.

Purpose of the Study:

• To identify prognostic factors for cancer recurrence and death in patients with PTC exhibiting tall cell morphology (PTC-TCM).
• To improve risk stratification and inform treatment strategies for this aggressive thyroid cancer subtype.

Main Methods:

• Retrospective cohort study of 365 patients with PTC-TCM treated between 1997 and 2018.
• Clinicopathologic features were analyzed using Kaplan-Meier and Cox proportional-hazards models.
• Outcomes assessed included locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and overall survival (OS).

Main Results:

• Positive surgical margins, lymph node positivity, and tumor size ≥3 cm were significant predictors of worse LRRFS.
• Factors associated with worse DRFS included older age, male sex, positive margins, nodal positivity, larger tumor size (≥1.5 cm), and the tall cell variant (TCV) classification.
• Male sex and larger tumor size (≥1.5 cm) were linked to worse OS.

Conclusions:

• Positive surgical margins, lymph node metastasis, and larger tumor size are critical risk factors for recurrence in PTC-TCM.
• The findings support considering intensified locoregional therapy, potentially including adjuvant radiation, for high-risk patients.
• A predictive nomogram for LRRFS was developed, aiding in risk assessment.