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Forleo R, Grani G, Alfò M, et al. Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4). Thyroid. 2021;doi: 10.1089/thy.2021.0248.
Forleo, R., Grani, G., Alfò, M., Zilioli, V., Giubbini, R., Zatelli, M. C., Gagliardi, I., Piovesan, A., Ragni, A., Morelli, S., Puxeddu, E., Pagano, L., Deandrea, M., Ceresini, G., Torlontano, M., Puligheddu, B., Antonelli, A., Centanni, M., Fugazzola, L., Spiazzi, G., Monti, S., Rossetto, R., Monzani, F., Tallini, G., Crescenzi, A., Sparano, C., Bruno, R., Repaci, A., Tumino, D., Pezzullo, L., Lombardi, C. P., Ferraro Petrillo, U., Filetti, S., Durante, C., & Castagna, M. G. (2021). Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4). Thyroid : official journal of the American Thyroid Association, . https://doi.org/10.1089/thy.2021.0248
Forleo, Raffaella, et al. "Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4)." Thyroid : official journal of the American Thyroid Association vol. (2021). doi: https://doi.org/10.1089/thy.2021.0248
Forleo R, Grani G, Alfò M, Zilioli V, Giubbini R, Zatelli MC, Gagliardi I, Piovesan A, Ragni A, Morelli S, Puxeddu E, Pagano L, Deandrea M, Ceresini G, Torlontano M, Puligheddu B, Antonelli A, Centanni M, Fugazzola L, Spiazzi G, Monti S, Rossetto R, Monzani F, Tallini G, Crescenzi A, Sparano C, Bruno R, Repaci A, Tumino D, Pezzullo L, Lombardi CP, Ferraro Petrillo U, Filetti S, Durante C, Castagna MG. Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4). Thyroid. 2021 Sep 19; doi: 10.1089/thy.2021.0248. Epub 2021 Sep 19. PMID: 34541894.
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Thyroid. 2021 Sep 19; doi: 10.1089/thy.2021.0248. Epub 2021 Sep 19.

Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4).

Thyroid : official journal of the American Thyroid Association

Raffaella Forleo, Giorgio Grani, Marco Alfò, Valentina Zilioli, Raffaele Giubbini, Maria Chiara Zatelli, Irene Gagliardi, Alessandro Piovesan, Alberto Ragni, Silvia Morelli, Efisio Puxeddu, Loredana Pagano, Maurilio Deandrea, Graziano Ceresini, Massimo Torlontano, Barbara Puligheddu, Alessandro Antonelli, Marco Centanni, Laura Fugazzola, Giovanna Spiazzi, Salvatore Monti, Ruth Rossetto, Fabio Monzani, Giovanni Tallini, Anna Crescenzi, Clotilde Sparano, Rocco Bruno, Andrea Repaci, Dario Tumino, Luciano Pezzullo, Celestino Pio Lombardi, Umberto Ferraro Petrillo, Sebastiano Filetti, Cosimo Durante, Maria Grazia Castagna

Affiliations

  1. University of Siena, 9313, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy; [email protected].
  2. Sapienza University of Rome, 9311, Dept. of Translational and Precision Medicine, Rome, Latium, Italy; [email protected].
  3. Sapienza University of Rome, 9311, Dept. of Statistical Sciences, Rome, Latium, Italy; [email protected].
  4. ASST Spedali Civili di Brescia, 18515, Chair and Nuclear Medicine Unit, Brescia, Lombardia, Italy; [email protected].
  5. ASST Spedali Civili di Brescia, 18515, Chair and Nuclear Medicine Unit, Brescia, Lombardia, Italy; [email protected].
  6. University of Ferrara, 9299, Dept of Medical Sciences, Unit of Endocrinology, Ferrara, Emilia-Romagna, Italy; [email protected].
  7. University of Ferrara, 9299, Dept of Medical Sciences, Unit of Endocrinology, Ferrara, Emilia-Romagna, Italy; [email protected].
  8. Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 18691, Division of Oncological Endocrinology, Torino, Piemonte, Italy; [email protected].
  9. Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, 18691, Division of Oncological Endocrinology, Torino, Italy; [email protected].
  10. University of Perugia, 9309, Dept. of Medicine and Surgery, Perugia, Umbria, Italy; [email protected].
  11. University of Perugia, 9309, Dept. of Medicine and Surgery, Perugia, Umbria, Italy; [email protected].
  12. Università degli Studi del Piemonte Orientale Amedeo Avogadro, 19050, Department of Translational Medicine, Novara, Piemonte, Italy; [email protected].
  13. Azienda Ospedaliera Ordine Mauriziano di Torino, 18693, Department of Medicine, Division of Endocrinology Diabetes and Metabolism, Torino, Piemonte, Italy; [email protected].
  14. University of Parma, 9370, Dept. of Medicine and Surgery, via Gramsci, 14 43126 Parma, ITALY, Parma, Emilia-Romagna, Italy, 43126; [email protected].
  15. Ospedale Casa Sollievo della Sofferenza, 9344, Department of Medical Science, Viale Cappuccini, San Giovanni Rotondo, Puglia, Italy, 71013; [email protected].
  16. Presidio Sanitario Gradenigo, 27284, SCDU Endocrinology, Andrology and Metabolism, Torino, Piemonte, Italy; [email protected].
  17. University of Pisa, 9310, Dept. of Surgical, Medical and Molecular Pathology and Critical Care, Pisa, Toscana, Italy; [email protected].
  18. Sapienza University of Rome, 9311, Experimental Medicine, Rome, Latium, Italy; [email protected].
  19. Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, 9354, Dept. of Endocrine and Metabolic Diseases, Milano, Lombardia, Italy; [email protected].
  20. Universita degli Studi di Verona, 19051, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Verona, Veneto, Italy; [email protected].
  21. Sapienza University of Rome, 9311, Dept. Of Endocrinology and Diabetes, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Latium, Italy; [email protected].
  22. University of Turin, 9314, Division of Endocrinology, Diabetology and Metabolism, Dept. of Medical Sciences, Torino, Piemonte, Italy; [email protected].
  23. University of Pisa, 9310, Geriatrics Unit, Dept. of Clinical and Experimental Medicine, Pisa, Toscana, Italy; [email protected].
  24. University of Bologna School of Medicine and Surgery, 60273, Pathology Unit, Dept. of Experimental, Diagnostic and Specialty Medicine, Bologna, Emilia-Romagna, Italy; [email protected].
  25. Campus Bio-Medico University Hospital, 220431, Pathology Unit, Roma, Lazio, Italy; [email protected].
  26. University of Florence, 9300, Endocrinology Unit, Dept. of Experimental and Clinical Biomedical Sciences "Mario Serio", Firenze, Toscana, Italy; [email protected].
  27. Tinchi Hospital, Endocrinology, Pisticci (Matera), Italy; [email protected].
  28. University of Bologna, 9296, Endocrinology Unit, Dept. of Medical and Surgical Sciences, Bologna, Emilia-Romagna, Italy; [email protected].
  29. University of Catania, 9298, Department of Clinical and Experimental Medicine, Catania, Sicilia, Italy; [email protected].
  30. Istituto Nazionale Tumori IRCCS Fondazione Pascale, 18730, Struttura Complessa Chirurgia Oncologica della Tiroide, Napoli, Campania, Italy; [email protected].
  31. Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, 60234, Endocrine Surgery, Lgo A Gemelli 8, Roma, Lazio, Italy, 00168; [email protected].
  32. Sapienza University of Rome, 9311, Dept. of Statistical Sciences, Rome, Latium, Italy; [email protected].
  33. Sapienza University of Rome, 9311, Dept. of Translational and Precision Medicine, Rome, Latium, Italy; [email protected].
  34. Sapienza University of Rome, 9311, Dept. of Translational and Precision Medicine, Rome, Latium, Italy; [email protected].
  35. University of Siena, 9313, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy; [email protected].

PMID: 34541894 DOI: 10.1089/thy.2021.0248

Abstract

BACKGROUND: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aim of this study was to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE.

METHODS: We reviewed all records in the Italian Thyroid Cancer Observatory (ITCO) database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines.

RESULTS: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p=0.65), tumor size >2 cm (OR 1.45, p=0.34), aggressive PTC histology (OR 0.55, p=0.15), and age at diagnosis (OR 0.90, p=0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27, 95% CI, p=0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and non-treated patients (p=0.24).

CONCLUSIONS: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease.

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