The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients.

Abstract

This study analyzed the impact of prognostic variables of age, sex, histopathological diagnosis, extent of disease at diagnosis, and surgical intervention on well differentiated thyroid carcinoma and how surgical treatment, radioactive iodine, and radiotherapy influence the patients' outcomes. There have been 1599 patients with well differentiated thyroid cancer treated and followed at the University of Texas M.D. Anderson Cancer Center from 1948 to 1989. The median follow-up for all patients was 11.0 yr, with the maximum follow-up being 43 yr and the minimum follow-up being 1 yr. The patients were predominantly female (2.3:1), with papillary (81%) and intrathyroidal carcinomas (42%) at the time of diagnosis. Sixty-six percent of the patients had a total thyroidectomy, 7% received external radiotherapy, and 46% had radioactive iodine as part of the treatment of the original disease; the overall recurrence rate was 23%, and the death rate was 11%. This study showed that treatment with radioactive iodine was the single most powerful prognostic indicator for increased disease-free interval (P less than 0.001) and that its use significantly increased survival as well. No benefit was obtained from treatment with external radiotherapy. Children had the best overall survival, but of the adult patients, females who had intrathyroidal papillary disease treated with total thyroidectomy, who had been given radioactive iodine, and whose disease had been diagnosed between 20-59 yr of age had the best prognosis.

Changing concepts in the pathogenesis and management of thyroid carcinoma

“…Hematogenous metastasis is more common for follicular carcinoma than for papillary carcinoma, and the prognosis is somewhat less favorable. Hürthle cell carcinoma, a malignancy derived from the follicular cell, has a prognosis similar to that of follicular carcinoma 4,14–21 …”

Effects of low‐iodide diet on postsurgical radioiodide ablation therapy in patients with differentiated thyroid carcinoma

“…Although controversy exists about the routine application of postsurgical radioiodide ablation of thyroid remnants, many clinics follow this procedure. An argument in favour of thyroid ablation is the beneficial effect on recurrence and mortality in patients with higher tumour stages and those with evident residual tumour after initial surgery (Simpson et al ., 1988; DeGroot et al ., 1990; Samaan et al ., 1992; Mazzaferri & Jhiang, 1994; Mazzaferri, 1997). In patients with small (< 1–1·5 cm) intrathyroidal tumours, no clear effect of thyroid ablation on recurrence and mortality rates appears to be present (DeGroot et al ., 1990; Hay et al ., 1992; Mazzaferri, 1997).…”

Papillary thyroid microcarcinoma

“…• Разрушение при терапии 131 I микроскопиче-ских фокусов опухоли, оставшихся после операции, может снизить вероятность рецидива и уровень ле-тальности [62,[64][65][66].…”