Of 123 patients identified, 60% had spread of the cancer outside of the neck at the time of presentation while in 40% the spread developed during follow-up period. Only 15 patients (12%) had low-risk features and all had spread of the cancer outside of the neck at the time of initial presentation. Of these, 11 were female and the average age was 63 years. The average size of the primary cancer was only 1.8 cm, and the smallest cancer was 2 mm. Also 8 patients had encapsulated follicular variant papillary thyroid cancer with invasion, 2 had infiltrative follicular variant papillary thyroid cancer, 2 had encapsulated Hürthle-cell carcinoma and ther was 1 pateint each with papillary microcarcinoma infiltrative follicular variant, encapsulated papillary thyroid cancer classical variant and encapsulated follicular carcinoma (n = 1 for each). The majority of these cancers had extensive fibrosis and calcifications.
Molecular analysis with next-generation sequencing was performed in 8 cases; RAS mutations were identified in 5 of these cases and TERT promoter mutations in 6 while a combination of TERT plus BRAF V600E or RAS mutations occurred in 4 cases. Overall, 4 of the 15 patients had died within 32 months of diagnosis. Distant cancer spread was most frequently present in the bone.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that patients with thyroid cancer that lack high-risk features have a very low rate of spread of the cancer outside of the neck. Those low-risk patients that do have spread of their cancer most frequently have spread of the cancer to bone at presentation and often have RAS and TERT promoter mutations in their cancer. This study suggests that TERT mutations may help to predict aggressive cancer in the absence of other risk factors and suggests that molecular markers be done on all patients with thyroid cancer.
— Alan P. Farwell, MD, FACE
ATA THYROID BROCHURE LINKS
Thyroid Cancer (Papillary and Follicular): https://www. thyroid.org/thyroid-cancer/