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Purpose <p>Locally advanced thyroid cancer (LATC) has gained increased attention, yet factors influencing invasion patterns and their prognostic impact remain poorly understood.</p> Methods <p>Patients with LATC were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Invasion patterns were visualized using bar graphs. Kaplan-Meier method and log-rank test analyzed outcomes by different invasion sites. Multivariable Cox regression analysis was conducted to adjust confounding factors and establish a new site-based risk stratification.</p> Results <p>Papillary thyroid carcinoma (PTC) predominantly invaded esophagus or larynx (21.0%) and trachea (26.3%), while follicular thyroid carcinoma/oncocytic thyroid carcinoma (FTC/OTC) mainly invaded blood vessel (31.3%). Anaplastic thyroid carcinoma (ATC) exhibited the highest rate of trachea invasion (33.3%) and multi-invasion (8.1%). Age, tumor size significantly influenced the proportion of trachea invasion (p &lt; 0.001). Locally advanced PTC patients with different invasion sites demonstrated significantly different prognoses: 10-year OS rate of each invasion site was: parathyroid or nerve (82.5%), bone or skeletal muscle (76.6%), esophagus or larynx (68.7%), blood vessel (58.0%), trachea (57.5%), multi-invasion (26.8%). Based on multivariable Cox regression, a novel site-based risk stratification was established for locally advanced PTC patients, with trachea invasion (HR = 1.83, p &lt; 0.001), blood vessel invasion (HR = 2.64, p &lt; 0.001), and multi-invasion (HR = 2.76, p &lt; 0.001) categorized as medium and high risk of mortality, respectively, demonstrating better discrimination than 8th AJCC staging system.</p> Conclusion <p>This study is the first to utilize population-based cohort to reveal factors influencing invasion sites and their prognostic differences. This study also proposed a new site-based risk stratification that builds upon 8th AJCC T staging for locally advanced PTC patients, which may facilitate more tailored clinical management strategies.</p>

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Influence factors and survival outcomes of different invasion sites in locally advanced thyroid cancer and new site-based risk stratification system

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月11日

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  • Zixia Tao,
  • Zheng Ding,
  • Bomin Guo,
  • Youben Fan,
  • Xianzhao Deng

摘要

Purpose

Locally advanced thyroid cancer (LATC) has gained increased attention, yet factors influencing invasion patterns and their prognostic impact remain poorly understood.

Methods

Patients with LATC were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Invasion patterns were visualized using bar graphs. Kaplan-Meier method and log-rank test analyzed outcomes by different invasion sites. Multivariable Cox regression analysis was conducted to adjust confounding factors and establish a new site-based risk stratification.

Results

Papillary thyroid carcinoma (PTC) predominantly invaded esophagus or larynx (21.0%) and trachea (26.3%), while follicular thyroid carcinoma/oncocytic thyroid carcinoma (FTC/OTC) mainly invaded blood vessel (31.3%). Anaplastic thyroid carcinoma (ATC) exhibited the highest rate of trachea invasion (33.3%) and multi-invasion (8.1%). Age, tumor size significantly influenced the proportion of trachea invasion (p < 0.001). Locally advanced PTC patients with different invasion sites demonstrated significantly different prognoses: 10-year OS rate of each invasion site was: parathyroid or nerve (82.5%), bone or skeletal muscle (76.6%), esophagus or larynx (68.7%), blood vessel (58.0%), trachea (57.5%), multi-invasion (26.8%). Based on multivariable Cox regression, a novel site-based risk stratification was established for locally advanced PTC patients, with trachea invasion (HR = 1.83, p < 0.001), blood vessel invasion (HR = 2.64, p < 0.001), and multi-invasion (HR = 2.76, p < 0.001) categorized as medium and high risk of mortality, respectively, demonstrating better discrimination than 8th AJCC staging system.

Conclusion

This study is the first to utilize population-based cohort to reveal factors influencing invasion sites and their prognostic differences. This study also proposed a new site-based risk stratification that builds upon 8th AJCC T staging for locally advanced PTC patients, which may facilitate more tailored clinical management strategies.