Risk Factors Contributing to a Poor Prognosis of Papillary Thyroid Carcinoma: Validity of UICC/AJCC TNM Classification and Stage Grouping
ABSTRACT In 2002, the UICC/AJCC TNM classification for papillary thyroid carcinoma was revised. In this study, we examined the validity of this classification system by investigating the predictors of disease-free survival (DFS) and cause-specific survival (CSS) in patients.
We examined various clinicopathological features, including the component of the TNM classification, for 1,740 patients who underwent initial and curative surgery for papillary carcinoma between 1987 and 1995.
Clinical and pathological T4a, clinical N1b in the TNM classification, and patient age were recognized as independent predictors of not only DFS, but also CSS of patients. Tumor size, male gender, and central node metastasis independently affected DFS only. There were 1,005 pathological N1b patients, but pathological N1b did not independently affect either DFS or CSS. Regarding the stage grouping, clinical stage IVA including clinical N1b more clearly affected DFS and CSS than pathological stage IVA including pathological N1b.
Clinical stage grouping was more useful than pathological stage grouping for predicting the prognosis of papillary carcinoma patients possibly because pathological stage overestimates the biological characteristics of many pathological N1b tumors.
- Clinical Cancer Research 05/2000; 6(4):1598-600. · 8.19 Impact Factor
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ABSTRACT: Follicular carcinoma is known to show a worse prognosis than papillary carcinoma because of distant metastasis in higher incidence. However, few studies have been published regarding the prognosis of follicular carcinoma patients in Japan, which prompted us to investigate this issue. We examined the prognosis and whether and how various clinicopathological features have affected disease-free survival (DFS) and cause-specific survival (CSS) of 334 patients who underwent initial surgery for follicular carcinoma. In 18 patients (5.4%), curative surgery could not be achieved because of distant metastasis at surgery in 17 patients and local extension in 1 patient. For 316 patients who underwent curative surgery, 5-year and 10-year DFS rates were 88.4% and 75.3%, respectively. Poorly differentiated carcinoma and widely invasive carcinoma, together with some conventional prognostic factors, predicted poorer DFS of patients. On multivariate analysis, poorly differentiated carcinoma was an independent prognostic factor for DFS. The 5-year and 10-year CSS rates for these 334 patients were 96.4% and 90.4%, respectively. Curative surgery and poorly differentiated carcinoma were recognized as independent prognostic factors. We can hypothesize that follicular carcinoma in Japan is generally a nonaggressive disease with a good prognosis. However, because poorly differentiated or widely invasive carcinomas showed a worse prognosis, postoperative pathological examination is important in predicting patient prognosis.World Journal of Surgery 08/2007; 31(7):1417-24. DOI:10.1007/s00268-007-9095-2 · 2.35 Impact Factor
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ABSTRACT: Since the 1990 s, asymptomatic papillary microcarcinoma (PMC), papillary carcinoma measuring <or= 1.0 cm, has frequently been detected using ultrasonographic screening and diagnosed by ultrasonography-guided fineneedle aspiration biopsy. Thyroid carcinoma was detected in 3.5% of otherwise healthy women aged >or= 30 years of age and most of these patients had lesions measuring <or= 1.5 cm in diameter, which is not discrepant with previous autopsy findings that latent PMC showed a high incidence. A recent observation trial showed that only 6.7% of low-risk PMC definitely became enlarged during 5 years of follow up, indicating that observation is an attractive alternative to surgery for PMC. However, PMC with clinically apparent metastasis detected on imaging is likely to show a recurrence to the lymph node and careful neck dissection as well as total thyroidectomy may be required. If surgical treatment is performed for low-risk PMC, prophylactic modified radical neck dissection is not necessary and lobectomy (with isthmectomy) and central node dissection is adequate if the tumor is located only in one lobe.Expert Opinion on Pharmacotherapy 12/2007; 8(18):3205-15. DOI:10.1517/14656518.104.22.16805 · 3.09 Impact Factor