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Vascular Invasion Predictive of Poor Prognosis in Thyroid Cancer


 

PARIS – Vascular invasion is highly predictive of long-term survival in thyroid cancer, and its presence or absence should be considered when determining a patient’s postsurgical follow-up plan, an investigator concluded from long-term follow-up of 725 patients.

Vascular invasion was present in 30% of the entire patient cohort. Their survival rates at 5, 10, and 20 years were significantly worse than the rates seen among those patients without vascular invasion (89% vs. 98%; 75% vs. 96%; and 70% vs. 92%, respectively).

“This is a very important prognostic factor for both follicular and papillary thyroid cancer,” Dr. Francoise Bonichon said at the International Thyroid Congress.

“If vascular invasion is present, the risk of thyroid cancer–related death is higher, and we classify the patient as ‘intermediate risk,’ with radioiodine ablation, suppression of thyroid-stimulating hormone, and follow-up every year that includes thyroglobulin and ultrasound,” she reported.

“If, on the other hand, there is no vascular invasion, we classify the patient as ‘low risk,’ except if there is another poor prognostic factor. This patient does not receive radioiodine ablation, and we keep the TSH normal.”

Dr. Bonichon of the Institut Bergoni? in Bordeaux presented the long-term follow-up data on patients treated at the hospital from 1960 to 2008. All had histologically confirmed nonmetastatic thyroid cancer with a tumor size of more than 1 cm. Most of the tumors (594) were papillary. Follicular thyroid cancer was confirmed in 128 patients; the remainder had poorly differentiated thyroid tumors.

Most of the patients (75%) were women; their mean age at diagnosis was 48 years. The median follow-up period was 12 years. About a quarter (22%) had already been exposed to neck radiation, most of them for Hodgkin’s disease.

For the analysis, Dr. Bonichon and her colleagues described vascular invasion as a cluster of tumor cells attached to the wall or protruding into the lumen of a vessel located at the periphery of the tumor, within or immediately outside the tumor capsule.

At the last follow-up, 70% of the cohort was alive with no evidence of thyroid cancer, 3% were alive with thyroid cancer, and 10% were dead from thyroid cancer. Another 2% were alive with other cancers, and 3% were dead from other cancers. In addition, 4% were alive with no information on health status, 7% had died from other problems, and 1% was lost to follow-up.

At 5 years, the overall survival rate was 92%; at 10 years, it was 83%. Those with papillary thyroid cancer had the best cancer-specific survival rates at 5, 10, and 20 years (98%, 95%, and 90%, respectively). Follicular cancer followed (95%, 85%, and 67%, respectively). Poorly differentiated cancers had the lowest survival rates (70%, 65%, and 40%, respectively).

“In our multivariate analysis, vascular invasion was as significant a risk factor for poor prognosis as age older than 45 years, tumor size more than 4 cm, and nodal status,” Dr. Bonichon said. “Vascular invasion is a simple, inexpensive factor that we can use in conjunction with age and other postoperative staging factors to tailor our decisions about radioiodine ablation, TSH suppression, and follow-up intensity.”

Dr. Bonichon had no potential conflicts of interest.

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