Prognostic factors study of differentiated thyroid cancerThe aim of this investigation was to evaluate the prognostic factors in patients with differentiated thyroid carcinoma treated and followed for a long period of time. Patients and Method: The following prognostic variables: gender, age at diagnosis, goiter characteristics, histology, differentiation grades, tumor anatomical extension, lymph node and distant initial metastasis and post treatment evolution were studied in a historical cohort of thyroid carcinoma. Surgical treatment was subtotal and total thyroidectomy plus lymphatic cervical selective neck dissection. Radioiodine was employed en 59.2% and thyroid hormone replacement was used indefi nitely. Kaplan Meyer analisis was employed to plot survival curves, log Rank test was used to establish the signifi cance of each variable and square chi to determine differences among groups. Cox model was used to identify prognostic variables. Results: A group of 477 patients with differentiated thyroid carcinoma treated at the Hospital San Juan de Dios, from 1948 to 1992, were studied. Median survival rate was 87% at the end of observation period. Univariate analysis showed signifi cant differences for age, tumor anatomical extension and histological grade on survival, for the entire serie. According to Cox model method, initial distant metastasis, age > 40 years, anatomical extension, tumor size > 10 mm, were determinant for unfavorable prognosis for the papillary cancer; distant metastasis, anatomical extension and age at the time of diagnosis were determinant for unfavorable prognosis for the follicular cancer. Conclusion: Overall survival was 87%. Distant metastasis at the time of diagnosis: age older than 40 years, anatomical extension and the size of the tumor were determinant of survival prognosis.Key words: Differentiated thyroid cancer, survival rate, prognostic factors. ResumenEl objetivo de esta investigación fue estudiar la supervivencia y los factores del pronóstico del cáncer diferenciado del tiroides tratado y seguido por un período de observación prolongado. Pacientes y Método: En una cohorte histórica prospectiva de cáncer de tiroides diagnosticada por biopsia quirúrgica, se analizó las variables:Rev.
One hundred forty-eight patients with differentiated carcinoma of the thyroid treated between May 1954 and April 1973 are presented. There were 89 papillary and 59 follicular carcinomas. They were classified according to Woolner criteria. Treatment consisted of surgery I-131 and thyroid hormone. Recurrences occurred in 8.7% of the patients, and lethality at the end of the observation period was 3.3%. The impact of histologic type, extent of the primary, and age of the patient at the time of treatment on prognosis were studied. The data were submitted to statistical analysis. This study revealed that these factors are determinant on prognosis. Best survival rates were observed in patients 40 years of age or younger at the time of treatment, in patients with intrathyroid papillary carcinomas, and in patients with noninvasive follicular carcinomas.
Thyroid cancer among children and adolescents Clinical and pathological features of 36 patients with thyroid cancer under 19 years of age were studied: at histological examination 55.5% (20 patients) had papillary carcinoma and 44.5% (16 patients) the follicular type of neoplasm. No cases of undifferentiated and medullary cancers were detected. Twenty two (61%) cases had single nodule goiters, while in 14 (39%) patients these were multinodular. Nine cases of early metastases to regional lymphatic tissues and 4 of distant metastases were seen. All patients underwent surgical treatment and were given replacement therapy with thyroid hormones. Additionally nineteen patients were treated postoperatively with I* 31. There were 4 cases of postoperative hypoparathyroidism, one of inferior laryngeal nerve lesion and one operating room death. Three regional recurrences of thyroid carcinoma were seen. Mean length of follow up was 15.4 (range 1 to 40) years and included all cases: there was only one death attributable to thyroid cancer. The prognosis and evolution of thyroid cancer in children and adolescents looks rather benign even in the presence of regional or long distance metastases.
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