To investigate the biological characteristics of papillary thyroid carcinoma from the perspectives of lymph node metastasis, lymph node recurrence, and distant metastasis, 746 patients with nonadvanced papillary thyroid carcinoma were retrospectively studied. There were 76 men and 670 women with a mean age of 42.7 years. The rate of lymph node metastasis was significantly higher in young patients (aged less than 30 years). Lymph node recurrence was observed in 80 patients and distant metastasis in 13, being seen with significant frequency in the young and elderly (aged over 50 years) patients and in the men. The frequency of distant metastasis was significantly greater in the elderly patients and in those with lymph node recurrence. These findings indicate that the role of regional lymph nodes and the clinical meaning of lymph node recurrence differ between young and elderly patients.
Prerequisites for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). "Early recurrence" was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
Follicular adenocarcinoma of the thyroid sometimes displays distant metastasis in spite of its low histological grade of malignancy. We have studied whether distant metastasis can be detected by the presence of blood vessel invasion. We have also examined the problem from the viewpoint of cell-to-cell conjugation. This study examined 160 cases of follicular adenocarcinoma of the thyroid. Histological specimens were made by sectioning tumors at their largest diameter. Blood vessel endothelia were specifically stained immunohistochemically with factor VIII-related antigen and Ulex europeaus agglutinin I (UEA-1). Then, the presence of blood vessel invasion was examined in detail. Furthermore, the conjugation of lectin-derived wheat germ agglutinin (WGA) to tumor cells was examined. Conjugation of tumor cells was also examined using sialic acid as a marker. Blood vessel invasion was recognized in 95 (59.4%) of 160 cases. Distant metastases were identified in 25 cases (15.6%) in which blood vessel invasion was also found. Relative to the group without distant metastases, the group with distant metastases showed not only a significantly higher sialic acid content but also higher levels of WGA-binding protein in the tissues. The risk of distant metastasis in patients with follicular adenocarcinoma of the thyroid appears to be related both to the extent and to the frequency of blood vessel invasion. Furthermore, assessment of the conjugation of cells appears to have predictive value for occurrence of distant metastases.
Eighty-four patients with locally advanced thyroid cancer treated during the period from 1965 to 1989 were studied in order to evaluate the appropriateness of radical surgery. There were 57 patients who underwent palliative surgery (palliative group) and 27 patients who underwent radical surgery (radical group). Forty-six of the patients in the palliative group and all 27 in the radical group were aged 40 years or more. The survival rates as analyzed by the Kaplan-Meier method revealed no significant difference between patients aged 40 or more in the palliative group and those in the radical group. The control of local disease, however, was much more difficult in the palliative group. From the view of survival rates, the superiority of radical surgery could not be demonstrated, but radical surgery did control local neck disease better. In the palliative group, the survival rate of patients aged under 40 was significantly better than that of patients aged 40 or more. It may thus be better to avoid radical surgery in patients under 40 if it would result in a severe deterioration in their quality of life.
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