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<p>To define the clinical, histopathological, and evolutionary profile of differentiated thyroid carcinomas (DTC) after systematic histological slide review according to the 2022 WHO classification, and to identify prognostic factors influencing disease-free survival (DFS). We conducted a retrospective cohort study over a 10-year period (2013–2023) in a tertiary referral center, including 133 patients surgically treated for DTC. Clinical, pathological, and follow-up data were collected from medical records. All available histological slides were re-examined in accordance with the 2022 WHO classification criteria. Disease-free survival was estimated using the Kaplan–Meier method. Prognostic factors associated with DFS were first analyzed in univariate analysis, followed by multivariate analysis using Cox proportional hazards regression to identify independent predictors. The cohort had a mean age of 47 ± 15.9 years (range 19–89) and showed marked female predominance (sex ratio 0.23). Survival outcomes were favorable, with 3-year, 5-year, and 10-year DFS rates of 90.8%, 90.3%, and 85.7%, respectively. Disease persistence occurred in 7.5% of cases, while 5.3% developed locoregional recurrence. In univariate analysis, age &gt; 55 years (<i>p</i> = 0.011), male sex (<i>p</i> = 0.019), cervical lymphadenopathy (<i>p</i> = 0.019), tumor size &gt; 4&#xa0;cm (<i>p</i> = 0.016), vascular emboli (<i>p</i> = 0.012), high-grade histology (<i>p</i> = 0.012), extrathyroidal extension (ETE) (<i>p</i> = 0.010), advanced pTNM stage (<i>p</i> = 0.002), locoregional recurrence (<i>p</i> &lt; 0.001), and metastatic disease at diagnosis (<i>p</i> = 0.018) were significantly associated with poorer DFS. Multivariate analysis identified absence of ETE (HRa = 5, 95% CI 1.32–18.9, <i>p</i> = 0.018) and early-stage disease (Stage I vs. IVb: HRa = 3.9, 95% CI 1.5–10.5, <i>p</i> = 0.006) as independent protective factors. DTC demonstrates an excellent long-term prognosis, with 10-year DFS exceeding 85%. Under the 2022 WHO classification framework, extrathyroidal extension and advanced TNM stage emerged as independent predictors of adverse outcomes, emphasizing the importance of early diagnosis and complete surgical management.</p>

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Experience of a Tunisian Tertiary ENT Center in the Prognostic Assessment of Differentiated Thyroid Carcinomas Based on the 2022 WHO Reclassification

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Jihène Houas,
  • Heyfa Belhadj-Miled,
  • Zeineb Nfikha,
  • Nihed Abdessaied,
  • Sana Bhiri,
  • Teheni Dardouri,
  • Monia Ghammam,
  • Wassim Kermani

摘要

To define the clinical, histopathological, and evolutionary profile of differentiated thyroid carcinomas (DTC) after systematic histological slide review according to the 2022 WHO classification, and to identify prognostic factors influencing disease-free survival (DFS). We conducted a retrospective cohort study over a 10-year period (2013–2023) in a tertiary referral center, including 133 patients surgically treated for DTC. Clinical, pathological, and follow-up data were collected from medical records. All available histological slides were re-examined in accordance with the 2022 WHO classification criteria. Disease-free survival was estimated using the Kaplan–Meier method. Prognostic factors associated with DFS were first analyzed in univariate analysis, followed by multivariate analysis using Cox proportional hazards regression to identify independent predictors. The cohort had a mean age of 47 ± 15.9 years (range 19–89) and showed marked female predominance (sex ratio 0.23). Survival outcomes were favorable, with 3-year, 5-year, and 10-year DFS rates of 90.8%, 90.3%, and 85.7%, respectively. Disease persistence occurred in 7.5% of cases, while 5.3% developed locoregional recurrence. In univariate analysis, age > 55 years (p = 0.011), male sex (p = 0.019), cervical lymphadenopathy (p = 0.019), tumor size > 4 cm (p = 0.016), vascular emboli (p = 0.012), high-grade histology (p = 0.012), extrathyroidal extension (ETE) (p = 0.010), advanced pTNM stage (p = 0.002), locoregional recurrence (p < 0.001), and metastatic disease at diagnosis (p = 0.018) were significantly associated with poorer DFS. Multivariate analysis identified absence of ETE (HRa = 5, 95% CI 1.32–18.9, p = 0.018) and early-stage disease (Stage I vs. IVb: HRa = 3.9, 95% CI 1.5–10.5, p = 0.006) as independent protective factors. DTC demonstrates an excellent long-term prognosis, with 10-year DFS exceeding 85%. Under the 2022 WHO classification framework, extrathyroidal extension and advanced TNM stage emerged as independent predictors of adverse outcomes, emphasizing the importance of early diagnosis and complete surgical management.