title: Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients.
abstract: It is uncertain whether more extensive primary surgery and increasing use of radioiodine remnant ablation (RRA) for papillary thyroid carcinoma (PTC) have resulted in improved rates of cause-specific mortality (CSM) and tumor recurrence (TR). Details of the initial presentation, therapy, and outcome of 2444 PTC patients consecutively treated during 1940-1999 were recorded in a computerized database. Patients were followed for more than 43,000 patient-years. The 25-year rates for CSM and TR were 5% and 14%, respectively. Temporal trends were analyzed for six decades. During the six decades, the proportion with initial MACIS (distant Metastasis, patient Age, Completeness of resection, local Invasion, and tumor Size) scores <6 were 77%, 82%, 84%, 86%, 85%, and 82%, respectively (p = 0.06). Lobectomy accounted for 70% of initial procedures during 1940-1949 and 22% during 1950-1959; during 1960-1999 bilateral lobar resection (BLR) accounted for 91% of surgeries (p <0.001). RRA after BLR was performed during 1950-1969 in 3% but increased to 18%, 57%, and 46% in successive decades (p <0.001). The 40-year rates for CSM and TR during 1940-1949 were significantly higher (p = 0.002) than during 1950-1999. During the last 50 years the 10-year CSM and TR rates for the 2286 cases did not significantly change with successive decades. Moreover, the 10-year rates for CSM and TR were not significantly improved during the last five decades of the study, either for the 1917 MACIS <6 patients or the 369 MACIS < 6 patients. Increasing use of RRA has not apparently improved the already excellent outcome, achieved before 1970, in low risk (MACIS <6) PTC patients managed by near-total thyroidectomy and conservative nodal excision.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. hay.ian@mayo.edu
authors.forename: Ian D
authors.initials: ID
authors.lastname: Hay
authors.forename: Geoffrey B
authors.initials: GB
authors.lastname: Thompson
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dvorak
authors.forename: Colum A
authors.initials: CA
authors.lastname: Gorman
authors.forename: Megan S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Bryan
authors.initials: B
authors.lastname: McIver
authors.forename: Brian P
authors.initials: BP
authors.lastname: Mullan
authors.forename: Ann L
authors.initials: AL
authors.lastname: Oberg
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Powell
authors.forename: Jon A
authors.initials: JA
authors.lastname: van Heerden
authors.forename: John R
authors.initials: JR
authors.lastname: Goellner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000639:trends; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes