Are the clinical and pathological features of differentiated thyroid carcinoma really changed over the last 35 years? Study on 4187 patients from a single Italian institution to answer this question.
ABSTRACT In the last decades, a marked increased prevalence of differentiated thyroid cancer (DTC) has been observed worldwide. The aim of this study was to evaluate the changing features of DTC referred to our institution between 1969 and 2004.
Clinical and pathological features and prognostic factors were analyzed in 4187 DTC patients, subdivided into two groups: group 1 (n = 1215) and group 2 (n = 2972) diagnosed before and after 1990, respectively.
Group 2 showed an increased proportion of micropapillary carcinoma and a concomitant decrease of follicular histotype. Male percentage was greater in group 2, whereas median age at diagnosis was unchanged. DTC of group 2 were more frequently associated with multinodular goiter or autoimmune thyroiditis, but many were unexpected findings. Features of aggressiveness were significantly less frequent in group 2, and the survival rate was greater (98.7 vs. 91.4%, P < 0.0001). Gender, age, histotype, tumor size, extrathyroidal macroinvasion, and lymph node and/or distant metastases were found to be poor prognostic factors in both groups using univariate analysis, but with multivariate analysis, only advanced age (odds ratio = 22.52 for older patients) and advanced stage (odds ratio = 53.54 for more advanced cases) were independently correlated with a lower survival.
DTC patients diagnosed after 1990 have smaller tumors with less advanced stage and a better prognosis. The question of whether this is related to the finding of tumors with a low clinical penetrance or to the anticipation of diagnosis remains to be clarified. Despite these significant differences, both advanced stage and older age still represent the most important poor prognostic factors for survival.
- SourceAvailable from: Carles Zafon03/2012; , ISBN: 978-953-51-0221-2
- 03/2012; , ISBN: 978-953-51-0299-1
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ABSTRACT: Radioiodine is a safe and well-established therapeutic modality for the ablation of thyroid remnants and the treatment of locoregional and distant metastases from differentiated thyroid carcinoma. However, a careful hazard assessment is mandatory in order to establish the risk–benefit ratio, especially in low-risk patients. Induction of second primary malignancies is one of the most serious possible untoward effects of radioiodine treatment. The limited incidence both of this effect and of thyroid cancer and the paucity of available dosimetric data make it difficult to perform high-quality studies that could provide evidence-based indications. A number of bias and confounding factors can blur data and must be considered, evaluating studies, addressing this topic. Data from the main surveys confirm that radioiodine can induce second primary tumors, with a probability comparable to that of external radiotherapy and lower than that of chemotherapy. Even though radioiodine treatment of thyroid cancer carries a low relative risk, the process of therapy justification must be carefully conducted and every measure that can reduce patient exposure must be taken, especially in children, adolescents and young adults.Clinical and Translational Imaging. 08/2013; 1(3).