Prognostic Impact of Histologic Grade for Papillary Thyroid Carcinoma

Allen S Ho^{1

2}, Michael Luu^{3

4}, Laurel Barrios³, Bonnie L Balzer^{3

5}, Shikha Bose^{3

5}, Xuemo Fan^{3

5}, Evan Walgama^{3

6}, Jon Mallen-St Clair^{3

6}, Usman Alam⁶, Iram Shafqat⁶, De-Chen Lin⁷, Yufei Chen⁸, Jennifer E Van Eyk⁹, Ellie G Maghami¹⁰, Glenn D Braunstein^{3

11}, Wendy L Sacks^{3

11}, Zachary S Zumsteg^{12

13}

Affiliations

¹ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. allen.ho@cshs.org.
² Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. allen.ho@cshs.org.
³ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁶ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁹ Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁰ Division of Head and Neck Surgery, City of Hope Medical Center, Duarte, CA, USA.
¹¹ Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹² Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. zachary.zumsteg@cshs.org.
¹³ Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. zachary.zumsteg@cshs.org.

PMID: 32808161
DOI: 10.1245/s10434-020-09023-2

Prognostic Impact of Histologic Grade for Papillary Thyroid Carcinoma

Allen S Ho et al. Ann Surg Oncol. 2021 Mar.

. 2021 Mar;28(3):1731-1739.

doi: 10.1245/s10434-020-09023-2. Epub 2020 Aug 17.

Authors

Affiliations

¹ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. allen.ho@cshs.org.
² Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. allen.ho@cshs.org.
³ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁵ Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁶ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁹ Advanced Clinical Biosystems Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹⁰ Division of Head and Neck Surgery, City of Hope Medical Center, Duarte, CA, USA.
¹¹ Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
¹² Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. zachary.zumsteg@cshs.org.
¹³ Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. zachary.zumsteg@cshs.org.

PMID: 32808161
DOI: 10.1245/s10434-020-09023-2

Abstract

Background: While numerous factors affect prognosis in papillary thyroid carcinoma (PTC), the comparative impact of histologic grade has not been well described. Moreover, indications for external beam radiation therapy (EBRT) remain imprecise. We evaluate clinicopathologic characteristics and outcomes for PTC stratified by grade.

Methods: We profiled histologic grade for PTC (well differentiated, moderately differentiated, poorly differentiated) via hospital (National Cancer Database) and population-based (Surveillance, Epidemiology, and End Results) registries. Cox regression was used to adjust for clinicopathologic covariates. Statistical interactions between subtypes and the effect of EBRT on survival were assessed.

Results: Collectively, worsening clinicopathologic factors (age, tumor size, extrathyroidal extension, nodal spread, M1 disease) and outcomes (disease-free survival, overall survival) correlated with less differentiated state, across all histologic grades (p < 0.001). Multivariable analysis showed escalating hazard with loss of differentiation relative to well-differentiated PTC (moderately differentiated hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.04-1.41, p = 0.02; poorly differentiated HR 2.62, 95% CI 2.23-3.08, p < 0.001). Correspondingly, greater survival benefit was associated with EBRT for poorly differentiated cases (HR 0.36, 95% CI 0.18-0.72, p = 0.004). This finding was upheld after landmark analysis to address potential immortal time bias (HR 0.37, 95% CI 0.17-0.80, p = 0.01).

Conclusions: Worsening histologic grade in PTC is independently associated with parallel escalation in mortality risk, on a scale approximating or surpassing established thyroid cancer risk factors. On preliminary analysis, EBRT was associated with improved survival in the most aggressive or least differentiated subvariants. Further investigation is warranted to examine the efficacy of EBRT for select poorly differentiated thyroid carcinomas.

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References

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Prognostic Impact of Histologic Grade for Papillary Thyroid Carcinoma

Affiliations

Prognostic Impact of Histologic Grade for Papillary Thyroid Carcinoma

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical