Changing Clinical, Pathologic, Therapeutic, and Survival Patterns in Differentiated Thyroid Carcinoma

Abstract

Records of 792 patients with differentiated thyroid carcinoma seen at the Lahey Clinic Foundation over a 40-year period were analyzed; 631 patients had a minimum followup period of 15 years. Differentiated types currently constitute nearly 90% of thyroid carcinomas. The clinical presentation has improved substantially through the years, and the results of treatment generally have improved. The per cent of patients with primarily incurable and locally unresectable disease or distant metastases has decreased from 7% before 1950 to 1% currently, and this group resulted in almost one third of the total fatalities and one half of fatalities within the first 5 years after treatment. Clear relationships were demonstrated between older age, men, extraglandular extension, blood vessel invasion, major capsular involvement, multifocal disease, and higher mortality rates. Lymph node metastases were found to exert a protective effect in all categories of disease analyzed, and this effect was directly related to the number of lymph node metastases present such that no deaths occurred in those patients who had more than 10 node metastases. Surgical treatment recommended is subtotal thyroidectomy for patients at high risk of death from disease as defined by combinations of age, sex, and extraglandular extension. Patients at low risk or with small carcinomas can be treated satisfactorily by lobectomy. Lymph node resections should be of a limited type or a modified neck dissection and should be performed only therapeutically. No improvement, as judged by mortality or recurrence rates, could be demonstrated by the use of radio therapy after surgery, and its use should be discouraged. Thyroid hormone administered for suppression of endogenous thyroid-stimulating hormone production improved mortality rates significantly in patients with papillary and mixed forms of carcinoma in all age groups but did not affect survival in patients with follicular carcinoma of the thyroid.20

Wysoko zróżnicowany rak tarczycy — czy nie leczysz swoich pacjentów zbyt intensywnie?

“…The excellent outcomes reported by the Lahey clinic in 1976 (5% mortality at 10 years) were supported by findings from other major groups and remain pertinent to this day [7,8].…”

Thyroid Carcinoma in Riyadh

“…Christensen, et al, 10 reported 94% in a defined population from Sweden. Cady, et al, 3 reported that differentiated types constitute 90% of thyroid carcinoma and, in the same report, he noted that through the four decades , undifferentiated forms became significantly less common, amounting to 9% over the period. Jacobs, et al, 11 in 1983, reported differentiated types constituted 81% of thyroid carcinoma.…”

“…Most of the cases have a differentiated histology. 1,2,3 However, there has been no prior documented study on the incidence and geographical distribution of thyroid cancer in the Kingdom of Saudi Arabia. Accordingly, a retrospective study was conducted to assess the histological type, age and sex distribution of malignancy in all thyroid specimens resected at three major referral centers in Riyadh, Saudi Arabia.…”

Reproductive factors and risk of thyroid cancer. A prospective study of 63,090 women from Norway

“…A striking female predominance is present in most series of differentiated thyroid carcinomas, especially below the age of 50 years (Cady et al, 1976;Akslen et al, 1990). Hormonal or other factors related to reproduction may, in part, explain this sex difference.…”