These survival curves demonstrate distinctly different prognostic outcomes between the different tumor stages (P < 0.0001, by log-rank test). Objective: This classification may be either clinical, based on evidence acquired before definitive treatment, or pathological (pTNM), when intraoperative and surgical pathological data are available. Young patients who succumbed to thyroid cancer were often found to have extrathyroidal invasion at presentation, as this constituted 5 of the 7 deaths in stage I patients who presented before 45 yr of age. Besides an overrepresentation of male patients among fatalities from all tumor stages, the absolute number of males who succumbed also outnumbered the females in stages I–III. However, 131 of 639 patients (20.5%) with initial cure had recurrence during follow-up; this increased progressively from 15.4% in stage I, to 22% in stage II, 46.4% in stage III, and 66.7% in stage IV tumors. Yao X, Meng Y, Guo R, Lu G, Jin L, Wang Y, Yang D. Cancer Manag Res. Background: 5. Conversely, those undergoing noncurative debulking surgery constituted a minority of patients with intrinsically poor prognosis and, therefore, are inappropriate for comparison. As the small patient numbers in stages II–IV preclude statistically meaningful evaluation of treatment according to tumor stage, patients with tumors more advanced than T1N0M0 were considered together (n = 492) in the respective Cox models. Simpson WJ, McKinney SE, Carruthers JS, Gospodarowicz MK, Sutcliffe SB, Panzarella T. Gilliland FD, Hunt WC, Morris DM, Key CR. Six hundred and twenty patients (89%) were classified with papillary thyroid cancer, and 80 patients (11%) had follicular thyroid cancer; the latter group included 8 patients with the Hurthle cell variant of follicular cancer. The study end point was either cancer recurrence or death from thyroid cancer. An interesting feature of the TNM staging system compared to other classifications is the age factor. 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. Although papillary thyroid carcinoma (PTC) usually has classic cytological characteristics on fine-needle aspiration (FNA), it can present rarely with aberrant features resembling those of histiocytes in a cystic nodule. However, controversies still exist regarding the benefit of thyroid remnant ablation, with others reporting no improvements (13, 31, 32). Preoperative features on ultrasound (US) imaging are different between follicular PTC and Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers. Although the cancer-specific survival rates are not statistically different between the two treatment subgroups, a trend toward reduced survival is noted beyond 20 yr of follow-up in the subgroup without 131I ablative therapy (Fig. The presence of cervical lymph node metastases has been variously reported to be associated with an unchanged (4, 8, 12, 13, 19), worse (1, 6), or even better (21) survival; the discrepancies in earlier reports may be contributed by their correlation with other prognostic factors. Nonparametric estimation from incomplete observations. Cancer-specific survival in patients with tumors other than T1N0M0 category, comparing the extensive surgery group (total or near-total thyroidectomy) vs. the limited surgery group (subtotal thyroidectomy or lobectomy). Advanced clinical stage (AJCC stage III or IV) at presentation. Total or near-total thyroidectomy was performed in 551 patients (78.7%), whereas 133 patients (19%) had lobectomy or subtotal thyroidectomy, and 16 patients (2.3%) had noncurative surgical debulking. 2021 Mar;32(1):44-62. doi: 10.1007/s12022-021-09666-1. Long-term impact of initial surgical, and medical therapy on papillary and follicular thyroid cancer. To date, however, clinical data based on this classification are lacking. Does the method of management of papillary thyroid carcinoma make a difference in outcome? A small proportion of patients with locally invasive tumor at presentation eventually succumbed to local effects of tumor invasion into vital structures, including massive hemoptysis, asphyxia, and venous obstruction. In our review, we found a higher rate of metastasis than previously reported. Various staging systems or risk group stratifications have been used extensively in the clinical management of patients with PTC, but the most predictive system for cancer-specific survival (CSS) based on distinct histologic types remains unclear. Clinical characteristics of the 700 patients by pTNM staging. P < 0.0001 for comparison between stages by Fisher’s exact test. Jin M, Kim ES, Kim BH, Kim HK, Yi HS, Jeon MJ, Kim TY, Kang HC, Kim WB, Shong YK, Kim M, Kim WG. N0 – No cancer cells were found in any of the lymph nodes examined. Although patients with follicular thyroid cancer constituted only 11% of the total cases, this histological type accounted for 42% of the cancer deaths. 1 Grading of TCC Murali Varma Cardiff, UK wptmv@cf.ac.uk Sarajevo Nov 2013 Urothelial carcinoma: Pathologic prognostic factors Stage •Most important Grade •Important only in non-muscle invasive (Ta/T1) tumours •esp. The primary operation was used as the entry date in survival models; statistical correction (left truncation up to the time of referral to UCSF) for disease-free survival was performed in patients referred for recurrent disease. Distant metastases in up to 5%. However, as the absolute differences between relative survival for males and females were small, the investigators concluded that gender is not a strong predictor of survival. DeGroot LJ, Kaplan EL, Straus FH, Shukla MS. Simpson WJ, Panzarella T, Carruthers JS, Gospodarowicz MK, Sutcliffe SB. Similar Cox modelling for the prognostic variables predicting thyroid cancer mortality are presented in Table 8. With regard to postoperative 131I ablative therapy, patients who were treated within 12 months of primary surgery with the intent to ablate normal functioning thyroid tissue and/or treat residual disease are considered in the 131I-treated category. Using actuarial survival plots, a clear separation in both disease-free survival and cancer-specific survival was noted among all the stages (P < 0.0001). Results from our analysis also support the use of adjuvant 131I ablative therapy in most patients who have undergone total or near-total thyroidectomy. Endocr Relat Cancer. Predictors of thyroid tumor aggressiveness. Patients with unifocal papillary cancers 1 cm or less in size (T1N0M0 category) were not given 131I treatment. Doctors use the results from diagnostic tests and scans to answer these questions: 1. Parathyroid stains: chromogranin A GATA3 parafibromin (CDC73) (pending) PTH (parathyroid hormone) synaptophysin thyroglobulin TTF1. 2. Segal K, Friedental R, Lubin E, Shvero J, Sulkes J, Feinmesser R. Segal K, Raveh E, Lubin E, Abraham A, Shvero J, Feinmesser R. Cady B, Sedgwick CE, Meissner WA, Brokwatter JR, Romagosa V, Werber J. Hughes CJ, Shaha AR, Shah JP, Loree TR. Regardless of the T and N categories, all patients under 45 yr without distant metastases (M0) are classified as stage I, whereas those with distant metastases (M1) belong only to stage II. Papillary thyroid carcinoma: the new, age-related TNM classification system in a retrospective analysis of 199 patients. With reference to pTNM stage I tumors, the RR of death from thyroid cancer was 5.5 in stage II, 11 in stage III, and 28 in stage IV tumors. 2. FOIA Papillary thyroid carcinoma (PTC) is considered a well differentiated neoplasm and is the most common thyroid gland malignancy accounting for 75–85% of all thyroid carcinomas []. Papillary thyroid cancer staging is a critical factor in choosing papillary thyroid cancer treatment treatments, papillary thyroid cancer extent of … Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Using matched pair analysis for similar prognostic risk factors, Hughes and co-workers found that nodal disease carried an increased risk of recurrence and a tendency toward lower 20-yr survival in patients 45 yr or older (22). Molecular Pathology of Non-familial Follicular Epithelial-Derived Thyroid Cancer in Adults: From RAS/BRAF-like Tumor Designations to Molecular Risk Stratification. Conversely, cancer mortality was 3.4-fold higher in follicular than papillary thyroid cancer. The 3 highest ranked staging systems by PVE were the Metastases, Age, Completeness of Resection, Invasion, Size (MACIS) (18.7) followed by the new AJCC/UICC 6th edition tumor, node, metastases (TNM) (17.9), and the European Organization for Research and Treatment of Cancer (EORTC) (16.6). In our series, the increased risk of cancer-specific death noted with follicular thyroid cancer persisted after correction for pTNM staging. Like subjects undergoing noncurative surgery, individuals receiving other adjuvant modalities (external radiation, immunotherapy, or systemic chemotherapy) constituted a noncomparable group with an inherently poor prognosis. Anaplastic thyroid cancer is very rare and is found in less than 2% of patients with thyroid cancer. Table 4 shows the type of primary surgery and adjuvant treatment administered to patients in the respective pTNM stages. Author information: (1)Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 612-896, South Korea, sartre81@gmail.com. Anaplastic thyroid cancer is the most advanced and aggressive thyroid cancer. However, the small patient numbers in pTNM stages other than stage I precludes us from evaluating its usefulness as a guide for therapy. All patients were placed on l-T4 suppressive therapy to maintain subnormal or unmeasurable serum TSH levels, depending upon their disease status. Despite past and recent efforts, there are a number of controversial issues in the classification and diagnosis of thyroid carcinomas (TC) that, … 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. Clearly overlaps morphologically and immunophenotypically with medullary carcinomabut the latter has a distinctive clinicopathologic setting CSS were calculated by Kaplan-Meier method and were compared by log-rank test. eCollection 2020. Cancer-specific survival in patients with tumors other than the T1N0M0 category, comparing the 131I ablation group vs. the no 131I ablation group (excluding patients receiving other types of adjuvant therapy). Epub … 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). After adjusting for age and gender, analysis of the variables used in TNM staging (tumor size, extent of primary tumor, and presence of nodal or distant metastases) uniformly depicted a significant association with tumor recurrence. P = 0.76 (NS) between treatment groups. Follow-up duration was calculated from the time of last evaluation or the time of death. Yüce I(1), Cağli S, Bayram A, Karasu F, Güney E. Author information: (1)Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Talas, 38039 Kayseri, Turkey. 2018 Feb;32:35-40. doi: 10.1016/j.anndiagpath.2017.09.002. Until better predictors of tumor behavior are available, the pTNM classification is shown to be useful for prognostication, and its widespread use will facilitate the exchange of information between centers. After adjusting for age and gender, analysis of the variables used in TNM staging similarly depicted a significant association between each variable and mortality. When predictability was measured by PVE, the MACIS system was the most predictive staging system and so should be the staging system of choice for PTC in the future. Similarly, Mazzaferri’s group found a significantly lower tumor recurrence rate in patients with larger (≥1.5 cm) tumors treated with 131I ablation and T4 suppression compared to those treated with T4 suppression alone, notwithstanding that patients given 131I ablative therapy had more adverse risk factors, such as invasive tumors and cervical nodal metastases (19, 30). Struma Ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Careers. In the past decade, the American Joint Committee on Cancer and the TNM Committee of the International Union against Cancer have agreed on acceptable rules for a staging system in cancer of the thyroid gland (9, 10). Indeed, the challenge would be to identify the risk factors that can effectively select out young patients with advanced disease who will show poor outcome from the majority with relatively good prognosis. Table 7 shows the risk ratio (RR) and 95% confidence interval of different prognostic variables for tumor recurrence obtained by Cox proportional hazards modelling. Psammoma bodies. Unable to load your collection due to an error, Unable to load your delegates due to an error. 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). or an associate. The mean age at diagnosis increased with more advanced tumor stages, although this was partly due to the age criteria used in the staging system (Table 1). For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Galectin-3 in NAFLD: therapeutic target or non-causal biomarker? Total body iodide scanning was repeated after 6–12 months, and reablation with 131I was performed if there was persistent uptake. Prevention and treatment information (HHS). Oxford University Press is a department of the University of Oxford. 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). The remaining 21 patients (3%) were treated by external radiation, immunotherapy, or systemic chemotherapy. It is difficult to establish a diagnosis of the follicular variant of papillary thyroid carcinoma (PTC) using fine‐needle aspiration cytology (FNAC). Using the Cox model with adjustment for age and gender, the variables used in TNM staging (namely tumor size, presence of extrathyroidal invasion, and initial nodal or distant metastatic lesions) are found to be important prognostic factors for recurrence or death from thyroid cancer. 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. The majority of patients receiving adjuvant therapy other than 131I ablation had locally advanced disease or distant metastases with poor avidity for iodide uptake. Palpable lymph nodes. Restaging of differentiated thyroid carcinoma by the sixth edition AJCC/UICC TNM staging system: stage migration and predictability. Pre-Tx iodine scan. P < 0.0001 between treatment groups. The observed differences are assumed statistically significant if the probability of chance occurrence is P < 0.05. Papillary Thyroid Cancer Staging. Ann Surg Oncol. Nuclear features of papillary thyroid carcinoma: Comparison of Core needle biopsy and thyroidectomy specimens Ann Diagn Pathol. Time-dependent variables were analyzed by the Cox proportional hazard models and the Kaplan-Meier product limit estimates of survival curves (15, 16). Postoperative adjuvant treatment with 131I ablation was administered in 426 patients (60.9%), whereas 253 patients (36.1%) received no adjuvant treatment. 2020 Aug 21;9(9):2708. doi: 10.3390/jcm9092708. PTC is associated with radiation exposure. Although it may be cautioned that the prognostic value of pTNM staging system could vary among groups of patients, its potential in providing risk stratification deserves further reporting from other centers. N1a – Cancer cells were found in one or more lymph node from levels 6 or 7. 2020 Sep 22;12:8787-8799. doi: 10.2147/CMAR.S265756. Encapsulated papillary carcinoma (EPC) is a rare entity of breast cancer accounting for approximately 1–2% of all breast tumours. 4. Mazzaferri and co-workers had earlier noted an increased risk of recurrence, but not mortality, in patients with nodal metastases (19); however, their more recent analysis of a larger patient cohort showed significantly higher 30-yr cancer recurrence and mortality rates in subjects with bilateral cervical or mediastinal lymph node metastases regardless of tumor histology (6). Keh-Chuan Loh, Francis S. Greenspan, Lauren Gee, Theodore R. Miller, Peter P. B. Yeo, Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients, The Journal of Clinical Endocrinology & Metabolism, Volume 82, Issue 11, 1 November 1997, Pages 3553–3562, https://doi.org/10.1210/jcem.82.11.4373. Prognosis is good. 2. 6. Ann Surg. The distributions by gender and tumor histology were different in the various stages (P < 0.0001). Hay ID, Grant CS, Taylor WF, McConahey WM. Association between TNM staging system and histopathological features in patients with papillary thyroid carcinoma. Kukkonen ST, Haapiainen RK, Franssila KO, Sivula AH. Is the differentiation between papillary and follicular thyroid carcinoma valid? 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. Furthermore, total thyroidectomy facilitates more effective 131I ablative therapy and the use of serum thyroglobulin levels as tumor marker for cancer recurrence during follow-up. Other sites of distant metastases noted were the pituitary, adrenal, liver, pericardium, peritoneum, and skin. Macroscopically suspicious nodes were excised, and modified radical neck dissections were performed in patients with confirmed nodal metastases. The surgical treatment of well-differentiated carcinoma of the thyroid. Epub 2021 Mar 2. Tumor recurrence was defined as new evidence of loco-regional disease or distant metastases occurring more than 6 months after successful primary therapy. Thyroid carcinoma as an example. Thyroid follicular epithelial-derived cancers include papillary, follicular, and anaplastic cancer. With regard to the major cause of cancer-specific deaths, 30% died from locally invasive tumor, whereas 70% died of distant metastases.
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