title: Outcome of the Diffuse Sclerosing Variant of Papillary Thyroid Cancer: A Meta-Analysis.
abstract: The diffuse sclerosing variant (DSV) of papillary thyroid cancer (PTC) is considered an aggressive histotype associated with poor prognosis. However, the available data for both the outcome and best management of this disease are inconsistent.
  
  
  
  This study reviewed the current literature by searching PubMed up to November 30, 2015, using the search terms "diffuse sclerosing variant" and "papillary thyroid cancer (or carcinoma)" and selecting only studies evaluating recurrent/persistent disease and cancer-related mortality in both DSV and classic PTC (cPTC). The association with some features of aggressiveness at diagnosis, the risk of recurrence or persistence, and the risk of cancer-related death were reported as odds ratio (OR) with confidence intervals (CI). Meta-regression analysis was used to assess the effect of covariates across the studies.
  
  
  
  Ten studies met the eligibility criteria and contributed 585 DSV and 64,611 cPTC patients. Relative to patients with cPTC, patients with DSV exhibited a higher risk of extrathyroidal extension and lymph node and distant metastases. The risk of persistent/recurrent disease was three times higher in patients with DSV than it was in cPTC patients (OR = 3.19 [CI 1.86-5.49]). This risk was not different when only studies where post-surgical (131)I was routinely administered were considered (OR = 2.07 [CI 0.88-4.90]). The risk of cancer-related mortality was not different between DSV and cPTC (OR = 1.34 [CI 0.76-2.38]).
  
  
  
  This meta-analysis confirms the aggressive biological behavior of DSV thyroid cancer. When preoperatively suspected, total thyroidectomy with lymph node excision followed by radioiodine therapy should be the correct management for DSV.
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Malandrino
authors.affiliation: 2 Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Policlinico "G. Martino," Messina, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Russo
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .
authors.forename: Concetto
authors.initials: C
authors.lastname: Regalbuto
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pellegriti
authors.affiliation: 2 Endocrinology, Department of Clinical and Experimental Medicine, University of Messina , Policlinico "G. Martino," Messina, Italy .
authors.forename: Mariacarla
authors.initials: M
authors.lastname: Moleti
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Caff
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Squatrito
authors.affiliation: 1 Endocrinology, Department of Clinical and Experimental Medicine, University of Catania , Garibaldi-Nesima Medical Center, Catania, Italy .|3 Humanitas, Catania Oncology Center , Catania, Italy .|4 Institute of Biostructures and Bioimaging , CNR (National Research Council), Catania, Italy .
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vigneri
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000473:pathology*