Well-differentiated thyroid carcinoma

Segal, Karl; Raveh, Eyal; Lubin, Ernesto; Abraham, Aristide; Shvero, Jacob; Feinmesser, Raphael

doi:10.1016/s0196-0709(96)90074-5

Cited by 27 publications

(34 citation statements)

References 15 publications

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“…With regard to the primary tumor size, none of the patients with an intrathyroidal tumor of 1 cm or less died of cancer, an observation similarly reported by others (6,19,20). Conversely, patients with extrathyroidal invasion (T4) had more than 3-fold risk of recurrence and death, respectively, compared to those with large intrathyroidal (T3) tumors, similar to the findings reported by DeGroot et al (4).…”

Section: Discussionsupporting

confidence: 83%

“…Although some investigators identified gender as a strong independent predictor of survival (1,8,12), others failed to show gender as a consistent independent prognostic factor (19,20,23). In a large population-based study by Gilliland and co-workers, the investigators found that males had a 50% greater risk of death than females after adjusting for other factors in the multivariate models (25).…”

Section: Discussionmentioning

confidence: 99%

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

Loh¹,

Greenspan²,

Gee³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

274

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The TNM classification (tumor-node-metastasis) was adopted by the American Joint Committee on Cancer and the International Union against Cancer a decade ago to avoid heterogeneity of prognostic classification schemes used for differentiated thyroid cancers. To date, however, clinical data based on this classification are lacking. We retrospectively evaluate the prognosis of 700 patients (208 men and 492 women) with papillary (89%) and follicular (11%) thyroid cancers according to the pathological TNM (pTNM) staging system, treated over a 25-yr period (1970 -1995). Patients who received primary treatment at our center constituted 87.4% of the cases; the majority underwent total thyroidectomy, followed by 131 I ablative therapy in high risk groups, as standard treatment. Clinical and follow-up data were obtained from the medical records and our cancer registry. Disease-free and cancer-specific survival data were analyzed by Kaplan-Meier product limit estimates and Cox proportional hazard models.Patient distribution by the pTNM system were: stage I, 516 patients; stage II, 57 patients; stage III, 104 patients; and stage IV, 23 patients. Over a mean Ϯ SE follow-up of 11.3 Ϯ 0.3 yr, the overall cancer recurrence and mortality rates were 20.5% and 8.4%, respectively. However, the respective cancer recurrence and mortality rates were distinctly different in the various pTNM stages: 15.4% and 1.7% in stage I, 22% and 15.8% in stage II, 46.4% and 30% in stage III, and 66.7% and 60.9% in stage IV tumors. Using actuarial survival plots, a clear separation in both disease-free survival and cancer-specific survival was noted among all the stages (P Ͻ 0.0001). Risk factors analyses showed a significant association between all the prognostic variables used in TNM staging (age, tumor size, extent of primary tumor, and presence of nodal or distant metastases) and the observed end points of recurrence or death from thyroid cancer. After correcting for TNM stages, the risk of cancer recurrence was halved in female compared to male patients, whereas this was 1.7-fold higher in multifocal than unifocal tumors. Conversely, cancer mortality was 3.4-fold higher in follicular than papillary thyroid cancer.In the analysis of effect of primary treatment among 492 patients with tumor more advanced than the T1N0M0 category, patients who underwent less extensive surgery (lobectomy or subtotal thyroidectomy) had a 2.5-fold risk of cancer recurrence (P Ͻ 0.0001) and a 2.2-fold risk of death (P Ͻ 0.01) compared to those who underwent total or near-total thyroidectomy. Patients not treated with 131 I ablation had a 2.1-fold greater risk of cancer recurrence (P Ͻ 0.0001) than those given 131 I ablation, although no difference was noted in deaths from thyroid cancer.Based on our data, the pTNM classification is useful in distinguishing patients with different prognostic outcomes. However, the small patient numbers in pTNM stages other than stage I precludes us from evaluating its usefulness as a guide for therapy. Until prospective data co...

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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

Loh¹,

Greenspan²,

Gee³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

274

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“…Fourteen percent of these studies included no patients who developed metastases, and 42% of the studies had one to five patients. To our knowledge, there are only three studies, in addition to ours, that have examined more than 30 patients with metastatic carcinoma (27,31,79). Two of these studies are by the same group of authors.…”

Section: Discussionmentioning

confidence: 91%

Metastatic Minimally Invasive (Encapsulated) Follicular and Hurthle Cell Thyroid Carcinoma: A Study of 34 Patients

2000

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Most studies that have examined minimally invasive, encapsulated, follicular carcinoma (FC) or Hurthle cell carcinomas (HCs) have contained only a few metastatic neoplasms. We studied 34 patients with a single, minimally invasive, metastatic FC or HC and compared them with 38 patients with similar, nonmetastatic FCs or HCs. The numbers of incomplete capsular penetration (neoplasm into but not through the capsule), complete capsular penetration (neoplasm through the capsule), and vascular invasion foci were quantified. The median number (three), range, and distribution of complete capsular penetration and vascular invasion foci were similar in the nonmetastatic and metastatic carcinomas. All of the metastatic FCs and HCs had at least one vascular invasion or complete capsular penetration focus. Sixty-two percent of the metastatic carcinomas had two to four complete capsular penetration foci, and 60% had two to four vascular invasion foci. Two metastatic neoplasms had incomplete capsular penetration but had one and two vascular invasion foci, respectively. One tumor had no vascular invasion but had four complete capsular penetration foci. No metastatic neoplasms had incomplete capsular penetration only. There were no differences in the number of vascular invasion or complete capsular penetration foci between metastatic and nonmetastatic FCs and HCs and between metastatic FCs and HCs. Most metastatic neoplasms had vascular space invasion and complete capsular penetration. The number of complete capsular penetration or vascular invasion foci was not associated with the initial site of metastasis or the interval between the surgery and the metastasis.

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“…In our group of patients, male gender had a statistically significant impact on poorer prognosis only in univariate analysis in FTC patients, whereas it could not be confirmed to be an independent risk factor in multivariate analysis. Other authors have also failed to prove gender as an independent prognostic factor (Simpson et al 1987, Segal et al 1996, Loh et al 1997.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors of papillary and follicular thyroid cancer: differences in an iodine-replete endemic goiter region.

Passler

Scheuba²,

Prager³

et al. 2004

Endocr Relat Cancer

140

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Papillary (PTC) and follicular thyroid carcinoma (FTC) are known as differentiated thyroid carcinoma (DTC). Nevertheless, according to the UICC/AJCC (TNM) classification PTC and FTC are frequently analyzed as one cancer. The aim of this study is to show differences in outcome and specific prognostic factors in an iodine-replete endemic goiter region.Six hundred and three patients with DTC treated within a 35-year-period were retrospectively analyzed with respect to carcinoma-specific survival. Prognostic factors were tested for their significance using univariate and multivariate analysis.The histological type (PTC versus FTC) was found to be a highly significant factor -carcinomaspecific survival both in univariate ðP < 0:001Þ and multivariate analyses ðP ¼ 0:003Þ was significantly different. Univariate analysis revealed patients' age, extra-thyroid tumor spread, lymph node and distant metastases, increasing tumor size, and the tall cell variant to be significant prognostic factors for PTC patients. Age !45 years, positive lymph nodes and increasing tumor size were confirmed as independent prognostic factors. Univariate analysis of FTC patients revealed age at presentation, gender, extrathyroidal tumor spread, lymph node and distant metastases, increasing tumor size, multifocality, widely invasive tumor growth and oxyphilic variant to be factors bearing prognostic significance. The presence of distant metastases and increasing tumor size could be identified as independent prognostic factors for FTC patients.This study shows distinctive differences in prognostic factors of PTC and FTC: independent factors predicting poor prognosis are age !45 years, positive lymph nodes and increasing tumor size for PTC, and distant metastases and increasing tumor size for FTC. PTC and FTC patients should be analyzed and reported separately.

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Well-differentiated thyroid carcinoma

Cited by 27 publications

References 15 publications

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

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

Metastatic Minimally Invasive (Encapsulated) Follicular and Hurthle Cell Thyroid Carcinoma: A Study of 34 Patients

Prognostic factors of papillary and follicular thyroid cancer: differences in an iodine-replete endemic goiter region.

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