Papillary carcinoma of the thyroid

Abstract

Between 1954 and 1993 503 patients with papillary carcinoma of the thyroid were treated at the Department of Otolaryngology-Head and Neck Surgery of the Beilinson Medical Center. Two thirds of these patients were women. The median follow-up period was 10.3 years. In more than 30% of cases the tumor was discovered because of the presence of an enlarged lymph node and/or invasion to adjacent structures. Total or near-total thyroidectomy was performed in 381 patients. The 48 patients in whom it was necessary to perform a reoperation had a significantly higher complication rate. Multicentricity was found in 65% of those cases in which both thyroid lobes were available for histologic examination. Nineteen patients were found to have a "tail" cell variant, 223 had a pure papillary variant, and 261 a follicular variant. The mortality rate was 6.2% 15 years after initial therapy. A number of factors-age, size of tumor, presence of distant metastases, "tall" cell variant, and type of surgery-were found to be significant predictors of survival. After almost 40 years of experience in treating more than 500 cases of papillary cancer, we have come to the conclusion that the surgical approach should be aggressive.

Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients

“…The overall cancer-specific mortality in our patients with papillary and follicular thyroid cancers was 8.4% at a mean follow-up period of 11.3 yr. This overall figure is very similar to those of several other series with comparable follow-up intervals (4,12,17). Nevertheless, mortality from thyroid cancer varied significantly across the different pTNM stages, ranging from 1.7% in stage I to 60.9% in stage IV tumors.…”

“…Until more data become available, our analysis of patients with differentiated thyroid cancer more advanced than the T1N0M0 category supports the current practice to manage these individuals more aggressively. In many studies, recurrence rates are evidently higher after a partial, compared to a total, thyroidectomy, even after adjustment for extent of disease (6,13,17,19,29). The impact of recurrence on survival is underscored by follow-up results indicating that up to 40 -50% of patients who die of thyroid cancer do so because of recurrent disease in the thyroid bed or central compartment of the neck (18).…”

Surgery of thyroid cancer in children and adolescents

“…In our series, of the 51 patients who underwent radical thyroid surgery, none had a local recurrence, compared with 3 of the 10 (30%) who underwent partial thyroidectomy; (5) Reoperation of the thyroid gland may be difficult and is associated with a higher risk of postoperative complications. 2,5,7,8 In our group, recurrent laryngeal nerve palsy and permanent hypocalcemia occurred in 5.2% of patients following the first operation and in 50% of the reoperated patients.…”

“…In our series, cervical lymph node metastases were a presenting sign in 49%, compared with the approximately 30% rate in adults. 5,7 Most authors report a lymphatic metastasis rate in young patients of approximately 50%. [8][9][10] A clear-cut relationship between thyroid cancer and previous neck radiotherapy has been established.…”

Time Trends of Incidence Rates of Thyroid Cancer in Israel: What Might Explain the Sharp Increase

“…Several factors determine the long-term survival in differentiated TC, including age, gender, distant metastases, and initial treatment (36)(37)(38)(39). Although we lack complete data on the treatment of patients, total thyroidectomy and iodine ablation became much more common in Israel for differentiated TC (40,41). Thus, improved survival rates in Israel could be due to earlier and more precise diagnosis and/or changes in treatment strategies.…”