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The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma

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Abstract

Background

Encapsulated angioinvasive follicular thyroid carcinoma (EAFTC) is associated with an increased risk of distant metastasis and reduced survival compared to minimally invasive follicular thyroid carcinoma (MIFTC). There is controversy regarding the extent of surgery and adjuvant radioactive iodine therapy for angioinvasive follicular thyroid carcinoma when stratified by number of foci of angioinvasion.

Methods

All follicular thyroid carcinoma cases from 1990–2018 were identified from a thyroid cancer database. Primary outcomes were distant metastasis-free survival (DMFS) and disease-specific survival (DSS) with factors of interest being age, gender, tumour size, treatment, foci of angioinvasion and histological subtype.

Results

A total of 292 cases were identified; 139 MIFTC, 141 EAFTC and 12 widely invasive follicular thyroid carcinoma (WIFTC). Over a follow-up period of 6.25 years, DMFS was significantly reduced (p < 0.001) with 14.2% (EAFTC) and 50% of WIFTC developing metastasis. The risk of metastasis in EAFTC with ≥ 4 foci of angioinvasion was 31.7% (HR = 5.89, p = 0.004), 6.3% for EAFTC with < 4 foci of angioinvasion (HR = 1.74, p = 0.47), compared to 3.6% MIFTC. Age ≥ 50 years (HR = 4.24, p = 0.005) and tumour size (HR = 1.27, p = 0.014) were significantly associated with increased risk of distant metastasis. DSS was reduced significantly (p < 0.001), with 7.8% EAFTC patients dying of disease. For EAFTC patients, DSS was 96.8% for < 4 foci and 82.6% for ≥ 4 foci of angioinvasion (p = 0.003).

Conclusion

EAFTC is at increased risk of distant metastasis related to the extent of angioinvasion. Tumours with < 4 foci of angioinvasion should be considered for a total thyroidectomy, particularly in older patients.

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Abbreviations

FTC:

Follicular thyroid carcinoma

EAFTC:

Encapsulated angioinvasive follicular thyroid carcinoma

MIFTC:

Minimally invasive follicular thyroid carcinoma

WIFTC:

Widely invasive follicular thyroid carcinoma

DMFS:

Distant metastasis-free survival

DSS:

Disease-specific survival

RAI:

Radioactive iodine

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Funding

Funding in the form of departmental funds was received for data-linkage with the New South Wales registry of births and deaths for survival data.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia

    David Leong, Anthony Glover, Mark Sywak & Stan Sidhu

  2. Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia

    Anthony J. Gill, Roderick Clifton-Bligh, Anthony Glover, Mark Sywak & Stan Sidhu

  3. Department of Anatomical Pathology, NSW Health Pathology, Royal North Shore Hospital, St. Leonards, NSW, Australia

    Anthony J. Gill

  4. Anatomical Pathology, Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia

    John Turchini

  5. Discipline of Pathology, Macquarie Medical School, Macquarie University, Macquarie Park, NSW, 2113, Australia

    John Turchini

  6. Department of Biostatistics, School of Public Health, University of Queensland, Herston, QLD, 4006, Australia

    Michael Waller

  7. Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, 2065, Australia

    Roderick Clifton-Bligh

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Leong, D., Gill, A.J., Turchini, J. et al. The Prognostic Impact of Extent of Vascular Invasion in Follicular Thyroid Carcinoma. World J Surg 47, 412–420 (2023). https://doi.org/10.1007/s00268-022-06696-6

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  • DOI: https://doi.org/10.1007/s00268-022-06696-6

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