Yao X, Meng Y, Guo R, Lu G, Jin L, Wang Y, Yang D. Cancer Manag Res. One tool that doctors use to describe the stage is the TNM system. Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers. Results from our analysis also support the use of adjuvant 131I ablative therapy in most patients who have undergone total or near-total thyroidectomy. Primary curative surgery was attempted in 97.7% of the total patients. Singer PA, Cooper DS, Daniels GH, et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. Table 9 examines the effect of the extent of primary surgery and the use of 131I ablative therapy on prognostic outcome. Yüce I(1), CaÄli S, Bayram A, Karasu F, Güney E. Author information: (1)Otorhinolaryngology and Head and Neck Surgery Department, Erciyes University, Talas, 38039 Kayseri, Turkey. Tumor recurrence was defined as new evidence of loco-regional disease or distant metastases occurring more than 6 months after successful primary therapy. 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. Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. 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). 1 These tumors are diagnosed using characteristic nuclear morphology; however, within the classification of "papillary thyroid carcinoma," there exist several distinct architectural and cytologic subtypes. To date, however, clinical data based on this classification are lacking. Preoperative features on ultrasound (US) imaging are different between follicular PTC and Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. Distribution of patients by pTNM staging between primary treatment cases (primary group) and patients referred for cancer recurrence (secondary group). 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. 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). 6. Unable to load your collection due to an error, Unable to load your delegates due to an error. Prognostic outcomes were obtained from follow-up examinations and the UCSF Cancer Registry. All 14 staging systems significantly predicted CSS (P < 0.001). 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). Our series revealed that the majority of thyroid cancer patients, excluding those with distant metastases at diagnosis, developed recurrence within the first 5 yr of diagnosis. Although improvement in cancer-specific survival was not observed in our patient cohort with 131I ablative therapy, Mazzaferri and Jhiang noted improvement in both cancer recurrence and mortality rates when the 131I-treated cohort was evaluated at a longer interval of 30 yr (6). Like all other thyroid cancer staging systems, the pTNM classification has limitations, as a minority of patients in the low risk group will die of thyroid cancer. Patients who received primary treatment at our center constituted 87.4% of the cases; the majority underwent total thyroidectomy, followed by 131I ablative therapy in high risk groups, as standard treatment. Does the method of management of papillary thyroid carcinoma make a difference in outcome? Karatzas T(1), Vasileiadis I(2), Zapanti ⦠Macroscopically suspicious nodes were excised, and modified radical neck dissections were performed in patients with confirmed nodal metastases. Pre-Tx iodine scan. Conversely, those undergoing noncurative debulking surgery constituted a minority of patients with intrinsically poor prognosis and, therefore, are inappropriate for comparison. Conclusion: In children, noniEFVPTC/NIFTP has indolent behavior, warranting consideration of less aggressive management, similar to adults. Treatment outcome of the 700 patients by pTNM staging. 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, distant metastases, commonly to the lungs, bones, or brain, accounted for most deaths from the other tumor stages. Post-Sx iodine scan. With regard to surgical treatment, the combined results of operations performed within 6 months of initial assessment are grouped together to indicate the extent of thyroidectomy, if these procedures constituted the intended primary surgical intervention. 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. In view of the unsettled controversy over the optimal primary treatment regimen for thyroid cancer, we secondarily examined the effect of treatment on prognosis in 492 patients with tumors more advanced than the T1N0M0 category. The observed differences are assumed statistically significant if the probability of chance occurrence is P < 0.05. 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. Objective: To find out the most predictive staging system for papillary thyroid carcinoma (PTC) currently available in the literature. Papillary thyroid carcinoma (PTC) is considered a well differentiated neoplasm and is the most common thyroid gland malignancy accounting for 75â85% of all thyroid carcinomas []. 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. World J Surg Oncol. Papillary thyroid carcinoma is usually discovered on routine examination as an 3 and 44, respectively, showing a clear separation of treatment outcome between the two surgical treatment subgroups. Clinical Implication of World Health Organization Classification in Patients with Follicular Thyroid Carcinoma in South Korea: A Multicenter Cohort Study. 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). In the cohort evaluated, patients without postoperative 131I ablation had a significantly higher risk of recurrence of, but not death from, thyroid cancer. Thyroid carcinoma as an example. Passler C, Prager G, Scheuba C, Kaserer K, Zettinig G, Niederle B. Ann Surg. 2. Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. P = 0.76 (NS) between treatment groups. 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). Despite past and recent efforts, there are a number of controversial issues in the classification and diagnosis of thyroid carcinomas (TC) that, ⦠Conclusions: Psammoma bodies. Please enable it to take advantage of the complete set of features! Careers. 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. The biological potential of multifocal thyroid cancer is uncertain, as most studies do not report an association between tumor multicentricity and prognosis (4, 8, 13, 23). 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. 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). THE PROPER staging and management of thyroid cancer are of great interest and concern. Disease-free and cancer-specific survival data were analyzed by Kaplan-Meier product limit estimates and Cox proportional hazard models. In view of the heterogeneous patient factors among different tumor stages, the effects of sex, tumor histology, and tumor focality were reevaluated after adjustment for pTNM staging: both gender and tumor focality remained as significant predictors of cancer recurrence, whereas tumor type did not confer an independent risk. Among 736 patients treated for papillary or follicular thyroid cancer (including the Hurthle cell variant) at the University of California-San Francisco (UCSF) Medical Center during the period from 1970–1995, 700 patients with complete data were studied retrospectively. We also performed risk factor analysis on various prognostic variables by using multivariate models. Nuclear features in the overlying epithelial cells, defined by nuclear enlargement, nuclear membrane irregularity and a distinct chromatin pattern. Hence, this was evaluated only in patients who had undergone a potentially curative operation followed by successful 131I ablative therapy in those with residual tumor. In our series, the increased risk of cancer-specific death noted with follicular thyroid cancer persisted after correction for pTNM staging. Patients with residual tumor or distant metastases were treated with a therapeutic dose ranging from 75–200 mCi 131I. Several morphologic variants of PTC have been described which account for up to 25% of all cases [ 2 ]. Methods: 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. The majority of patients receiving adjuvant therapy other than 131I ablation had locally advanced disease or distant metastases with poor avidity for iodide uptake. Medical school memory device P's: 1. 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. 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. 2021 Mar;32(1):44-62. doi: 10.1007/s12022-021-09666-1. 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. The distributions by gender and tumor histology were different in the various stages (P < 0.0001). All patients were placed on l-T4 suppressive therapy to maintain subnormal or unmeasurable serum TSH levels, depending upon their disease status. However, the vast majority of young individuals with extrathyroidal invasion at diagnosis demonstrated an otherwise benign course. 2020 Sep;35(3):618-627. doi: 10.3803/EnM.2020.742. Notes: 1. Table 4 shows the type of primary surgery and adjuvant treatment administered to patients in the respective pTNM stages. DeGroot and co-workers also found that 131I ablation was associated with a significant reduction of recurrences independent of the extent of surgery, and they supported postoperative 131I ablation of residual thyroid tissue in low risk papillary thyroid cancer patients with tumors greater than 1 cm (4, 29). Similar Cox modelling for the prognostic variables predicting thyroid cancer mortality are presented in Table 8. Dynamic Risk Stratification for Predicting Treatment Response in Differentiated Thyroid Cancer. Objective: Author information: (1)Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 612-896, South Korea, sartre81@gmail.com. Bethesda, MD 20894, Copyright M (metastasis): M0, no distant metastasis; M1, distant metastasis. National Library of Medicine Oxford University Press is a department of the University of Oxford. Papillary thyroid carcinoma: the new, age-related TNM classification system in a retrospective analysis of 199 patients. Mazzaferri and Jhiang (6) likewise noted a higher mortality in patients with follicular thyroid cancer, but this significance was lost when subjects who presented with distant metastases at diagnosis were excluded. 3. All of the currently available staging systems predicted CSS well in patients with PTC regardless of which histologic type from which they were derived. CSS were calculated by Kaplan-Meier method and were compared by log-rank test. However, based on the 3.4-fold higher cancer mortality risk obtained by multivariate analysis, it is prudent to consider total thyroidectomy as standard surgery in most patients with follicular thyroid cancer, followed by 131I ablation if focal iodide uptake is evident on diagnostic scanning (26, 33). N0 â No cancer cells were found in any of the lymph nodes examined. 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. Table 7 shows the risk ratio (RR) and 95% confidence interval of different prognostic variables for tumor recurrence obtained by Cox proportional hazards modelling. With reference to pTNM stage I tumors, the RR of recurrence was 2.5 in stage II, 5.6 in stage III, and 32 in stage IV tumors. Regional metastatic pattern of papillary thyroid carcinoma. 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). DeGroot LJ, Kaplan EL, Straus FH, Shukla MS. Simpson WJ, Panzarella T, Carruthers JS, Gospodarowicz MK, Sutcliffe SB. This is usually followed by a 30- to 50-mCi out-patient dose radioactive 131I ablation of residual thyroid tissue 6–12 weeks after operation if focal uptake is detected in the thyroid bed on a 2- to 3-mCi 131I diagnostic scan. Clinical and follow-up data were obtained from the medical records and our cancer registry. Total or near-total thyroidectomy has been used as a standard treatment in our institution for differentiated thyroid cancer since 1970. Background: The impact of extranodal extension (ENE) of metastatic papillary thyroid carcinoma (PTC) on short- and long-term clinical outcomes, including biochemical testing, has not been reported. 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. 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. Among patients who succumbed to thyroid cancer, the time to death progressively decreased from stage I–IV tumors. Through a comprehensive MEDLINE search from 1965 to 2005, a total of 17 staging systems were found in the literature and 14 systems were applied to the 589 PTC patients managed at our institution from 1961 to 2001. This underscores that surveillance should be life-long, but may be performed less frequently when a decade or more has passed with no evidence of relapse. Kukkonen ST, Haapiainen RK, Franssila KO, Sivula AH. The study cohort consisted of 208 male and 492 female patients (male/female ratio = 1:2.4). eCollection 2020. Value of Ultrasound Combined with Immunohistochemistry Evaluation of Central Lymph Node Metastasis for the Prognosis of Papillary Thyroid Carcinoma. Staging is the process of finding out if and how far a cancer has spread. (25) found that patients with follicular cancer have lower survival rates than those with papillary cancer, but they noted that the prognosis is more strongly determined by tumor staging and other factors than by tumor histology. Until more data are available, it is believed prudent to manage patients with multifocal tumors by total or near-total thyroidectomy and 131I remnant ablative therapy (6, 20, 26). Papillary thyroid carcinoma: a multivariate analysis of prognostic factors including an evaluation of the p-TNM staging system. DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Galectin-3 in NAFLD: therapeutic target or non-causal biomarker? 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). 2. 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. Patients with follicular thyroid cancer in our series are not evaluated separately, as they constituted only 11% of the study cohort. 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. 1 Grading of TCC Murali Varma Cardiff, UK wptmv@cf.ac.uk Sarajevo Nov 2013 Urothelial carcinoma: Pathologic prognostic factors Stage â¢Most important Grade â¢Important only in non-muscle invasive (Ta/T1) tumours â¢esp. Conclusions: Warthin-like tumors can be mistaken for benign lymphoepithelial lesions of the thyroid, Hürthle cell carcinoma, and tall cell variant of papillary carcinoma in both fine-needle aspiration and histology specimens. Treatment outcome and follow-up data are summarized in Table 5. One fifth of the patients who had died from thyroid cancer were less than 45 yr of age at the time of primary evaluation and treatment of their malignancy, whereas 62% of the overall patients were in this age category. Anaplastic thyroid cancer is very rare and is found in less than 2% of patients with thyroid cancer. Doctors use the results from diagnostic tests and scans to answer these questions: 1. This finding is consistent with other series and emphasizes the need for frequent follow-up examinations regardless of low risk categories, especially during the first 5 yr after primary surgery (11, 18). Epub 2007 Feb 21. However, the primary treatment regimen among the patients treated elsewhere was heterogeneous, and many had less extensive surgery or no 131I ablation. The mean± se age at diagnosis was 41.1 ± 0.3 yr; the values for male and female patients were 44.6 ± 1.1 and 39.7 ± 0.7 yr, respectively. Using Cox proportional hazards analysis, the relative importance of each staging system in determining CSS was calculated by the proportion of variation (PVE). Patients not treated with 131I ablation had a 2.1-fold greater risk of cancer recurrence (P < 0.0001) than those given 131I ablation, although no difference was noted in deaths from thyroid cancer. P < 0.0001 between treatment groups. Local recurrence. Malignant Struma Ovarii is a very rare disease and there are various approaches to treatment based on staging. Differentiated thyroid cancer constitutes the commonest endocrine malignancy, and because of its generally favorable course, various tumor-staging schemes have been formulated to improve risk group assignment of affected individuals (1–8). To find out the most predictive staging system for papillary thyroid carcinoma (PTC) currently available in the literature. In these cases, lobectomy was considered adequate if there were no risk factors, such as radiation exposure or family history of thyroid cancer. Papillary thyroid carcinoma is given a nodal stage of 0 or 1 based on the presence or absence of tumour cells in a lymph node and the location of the involved lymph nodes. 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. The surgical treatment of well-differentiated carcinoma of the thyroid. P < 0.0001 comparing the proportions with initial cure, cancer recurrence, and cancer deaths, respectively, among the different stages by Wilcoxon rank sum test. CAP Approved Endocrine ⢠Thyroid Gland Thyroid 4.0.0.0 For Papillary, Follicular, Poorly Differentiated, Hurthle Cell and Anaplastic Thyroid Carcinoma Primary Tumor (pT) ___ pTX: Primary tumor cannot be assessed ___ pT0: No Risk factors for thyroid cancer deaths by Cox models. In conclusion, our data support the use of pTNM staging system for differentiated thyroid cancer. Extrathyroidal extension and nodal metastases in up to 55%. FOIA The disease-free and cancer-specific survival for patients with extensive surgery (total or near-total thyroidectomy) vs. limited surgery (lobectomy or subtotal thyroidectomy) are depicted in Figs. Until recently, the proliferation of numerous classifications created the problem that there was no generally accepted staging scheme for thyroid cancer. Until more data become available, our analysis of patients with differentiated thyroid cancer more advanced than the T1N0M0 category supports the current practice to manage these individuals more aggressively. Other sites of distant metastases noted were the pituitary, adrenal, liver, pericardium, peritoneum, and skin. However, the small patient numbers in pTNM stages other than stage I precludes us from evaluating its usefulness as a guide for therapy. Distributions of age, sex, and tumor type in the respective pTNM stages are presented in Table 3. Although most of the young subjects who died from stage I tumor had locally advanced disease, the vast majority of the young cohort with extrathyroidal invasion at diagnosis demonstrated a benign course. 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). 2007 Jul;246(1):114-21. doi: 10.1097/01.sla.0000262785.46403.9b. Data were analyzed using SAS system 6.11 statistical software (SAS Institute, Cary, NC). Prevention and treatment information (HHS). 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. Time to recurrence was evaluated in patients with recurrent disease as the interval from primary treatment that resulted in cure to the first episode of cancer recurrence. These survival curves demonstrate distinctly different prognostic outcomes between the different tumor stages (P < 0.0001, by log-rank test). Struma Ovarii with a focus of papillary thyroid cancer: a case report and review of the literature. Papillary Thyroid Cancer Staging. All specimens obtained at surgery or outside histology slides were reviewed by a senior pathologist (T.R.M.) 2003 Feb;237(2):227-34. doi: 10.1097/01.SLA.0000048449.69472.81. Treatment characteristics of the 700 patients by pTNM staging. Prognosis of papillary thyroid cancer in patients with Graves' disease: a propensity score-matched analysis. P < 0.0001 among all stages. 4. Author information: (1)Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. Clinical characteristics of the 700 patients by pTNM staging. Initial cure, as defined by serum thyroglobulin concentrations less than 4 ng/dL and/or negative total body iodide scans, was achieved in more than 90% of patients after primary treatment of thyroid cancer; this fell from 96.7% in stage I to 87.7% in stage II, 80.8% in stage III, and 26.1% in stage IV tumors. Changing concepts in the pathogenesis and management of thyroid carcinoma. Breakdown of cancer mortality in the various pTNM stages (respective cells depicting the distribution by the number of deaths). Time-dependent variables were analyzed by the Cox proportional hazard models and the Kaplan-Meier product limit estimates of survival curves (15, 16). As shown in Table 1, the TNM system relies on assessment of three components: the extent of primary tumor (T), the absence or presence of regional lymph node metastases (N), and the absence or presence of distant metastatic lesions (M). However, Mazzaferri and Jhiang (6) reported increased cancer mortality rates in patients with three or more foci of papillary or follicular thyroid cancers, although this association was lost in multivariate analysis. There were no predisposition of age, sex, or the major cause of death between patients who died from papillary and follicular thyroid cancers. In the group referred for recurrent disease, there were proportionately fewer patients with stage I but more patients with stage III and IV tumors (P < 0.0001). The remaining 21 patients (3%) were treated by external radiation, immunotherapy, or systemic chemotherapy. 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. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Patients with T2 tumors, however, showed a nonsignificant trend toward an increased mortality over T1 tumors. An expanded view of risk-group definition in differentiated thyroid carcinoma. 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. Table 2 shows the distribution of patients according to pTNM staging: stage I, 516 patients; stage II, 57 patients; stage III, 104 patients; and stage IV, 23 patients. Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid, contributing to over 70% of thyroid cancers. 2007 May;14(5):1551-9. doi: 10.1245/s10434-006-9242-2. 2020 Aug 21;9(9):2708. doi: 10.3390/jcm9092708. The histological classification was made according to the WHO criteria (14).
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