Impact of Therapy for Differentiated Carcinoma of the Thyroid: An Analysis of 706 Cases*

Abstract

A retrospective analysis of clinical and pathological data was conducted on 706 patients (514 females and 192 males) treated for differentiated thyroid carcinoma at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1951 to 1975 and followed to 1981. The histological diagnoses were mixed papillary/follicular carcinoma (66.7%), papillary carcinoma (14.6%), follicular carcinoma (15.3%), or Hurthle cell carcinoma (3.4%). Patients diagnosed before the age of 40 yr lived significantly longer than those diagnosed over the age of 40 yr, and females lived longer than males. According to survival analyses and disease-free intervals, the order of increasing aggressiveness of the tumors was papillary, mixed, follicular, and Hurthle cell. Total thyroidectomy was associated with longer disease-free intervals and fewer recurrences. The 136 patients who received ablative 131I after surgery had fewer recurrences than a matched group who did not, but the disease-free interval and survival rate showed no significant difference. Further classification showed that patients with follicular and mixed tumors, and those who underwent total thyroidectomy benefited from 131I. There were 78 deaths attributed to thyroid cancer in the whole group. Approximately two thirds occurred in the first 10 yr after diagnosis. In conclusion, total thyroidectomy is recommended, when feasible, for differentiated thyroid cancer, followed by ablative 131I therapy, at least for follicular and mixed varieties.

Thyroid Carcinoma in Riyadh

“…Russell, et al, 2 reported an incidence of 65% papillary and papillarypredominant and 35% follicular and follicular-predominant, based upon whole organ section. Samann, et al, 12 reported an incidence of papillary and mixed types of 81%, and follicular of 15%. Farrar, et al, 13 reported an incidence of 80% papillary and 20% follicular.…”

“…This could suggest a more favorable prognosis, since papillary type carries a better prognosis than follicular type. 2,3,12,14 Out of 78 differentiated carcinomas, there were 27 (35%) males and 51 (65%) females; a male:female ratio of 1:1.9. This is consistent with Cady's 3 findings of an increasing incidence of males with differentiated carcinoma in succeeding decades from 19% in the 1930's to 34% in the 1960's, with resulting changes in male:female ratio during the period from 1:4 to 1:2.…”

“…It has been reported that the combination of sex and age is significantly related to mortality 3,12,14,15 and high risk for men begins at the age of 40 but for women at the age of 50. 3 Also, evidence has been presented that welldifferentiated thyroid carcinomas behave more aggressively when the diagnosis is made after the age of 40, 12,14,16 and that females have lower recurrence rates, longer disease-free intervals and longer survival rates than males. 3,12 Therefore, because 95% of the carcinomas were differentiated and 87% of the them were of the papillary type, along with the relative youth of our cases, we might expect a favorable prognosis.…”

“…3 Also, evidence has been presented that welldifferentiated thyroid carcinomas behave more aggressively when the diagnosis is made after the age of 40, 12,14,16 and that females have lower recurrence rates, longer disease-free intervals and longer survival rates than males. 3,12 Therefore, because 95% of the carcinomas were differentiated and 87% of the them were of the papillary type, along with the relative youth of our cases, we might expect a favorable prognosis. Sixty-six percent of the papillary type were in females with the majority (89%) under 50 years of age.…”

Phase 2 clinical trial of sunitinib as adjunctive treatment in patients with advanced differentiated thyroid cancer

“…DTC recurrence rate has been reported to be 1.4-23% (8,9) and depends on the initial and ongoing risk stratification (10). The mortality of patients with a recurrence has been shown to be as high as 38-69% (11,12). Furthermore, 2-5% of patients with initially differentiated tumors can develop refractoriness to radioiodine and iodine-131 ( 131 I)-negative metastases.…”