Endocrinol Metab.  2020 Sep;35(3):618-627. 10.3803/EnM.2020.742.

Clinical Implication of World Health Organization Classification in Patients with Follicular Thyroid Carcinoma in South Korea: A Multicenter Cohort Study

• Jin M
• Kim ES
• Kim BH
• Kim HK
• Yi HS
• Jeon MJ
• Kim TY
• Kang HC
• Kim WB
• Shong YK
• Kim M
• Kim WG

• KMID: 2508012
• DOI: http://doi.org/10.3803/EnM.2020.742

Abstract

Background
The study aimed to compare the prognostic value of the 4th edition of World Health Organization classification (WHO-2017) with the previous WHO classification (WHO-2004) for follicular thyroid carcinoma (FTC).
Methods
This multicenter retrospective cohort study included 318 patients with FTC from five tertiary centers who underwent thyroid surgery between 1996 and 2009. We evaluated the prognosis of patients with minimally invasive (MI), encapsulated angioinvasive (EA), and widely invasive (WI) FTC according to WHO-2017. Further, we evaluated the proportion of variation explained (PVE) and Harrell’s C-index to compare the predictability of disease-free survival (DFS) and disease-specific survival (DSS).
Results
In total, 227, 58, and 33 patients had MI-, EA-, and WI-FTC, respectively. During a median follow-up of 10.6 years, 46 (14.5%) patients had disease recurrence and 20 (6.3%) patients died from FTC. The 10-year DFS rates of patients with MI-, EA-, and WI-FTC were 91.1%, 78.2%, and 54.9%, respectively (P<0.001, PVE=7.1%, C-index=0.649). The corresponding 10-year DSS rates were 95.9%, 93.5%, and 73.5%, respectively (P<0.001, PVE=2.6%, C-index=0.624). The PVE and C-index values were higher using WHO-2017 than using WHO-2004 for the prediction of DFS, but not for DSS. In multivariate analysis, older age (P=0.02), gross extrathyroidal extension (ETE) (P=0.003), and distant metastasis (P<0.001) were independent risk factors for DSS.
Conclusion
WHO-2017 improves the predictability of DFS, but not DSS, in patients with FTC. Distant metastasis, gross ETE and older age (≥55 years) were independent risk factors for DSS.

Keyword

Thyroid neoplasms; Adenocarcinoma; follicular; World Health Organization; Recurrence; Survival

Figure

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  Fig. 1 (A) Disease-free survival curves according to World Health Organization (WHO)-2004. (B) Disease-free survival curves according to WHO-2017. (C) Disease-free survival curves according to the degree of extrathyroidal extension (ETE). (D) Disease-free survival curves according to the presence of vascular invasion.

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  Fig. 2 (A) Disease-specific survival curves according to World Health Organization (WHO)-2004. (B) Disease-specific survival curves according to WHO-2017. (C) Disease-specific survival curves according to the degree of extrathyroidal extension (ETE). (D) Disease-specific curves according to the presence of vascular invasion.

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