title: Survival and death causes in differentiated thyroid carcinoma.
abstract: BACKGROUND
  Survival studies in differentiated thyroid carcinoma (DTC) may be biased because they have been performed in heterogeneous populations. In addition, specific death causes in DTC have not been documented well in the literature.
  
  
  OBJECTIVE
  The aim of our study was to investigate survival and specific death causes in a homogeneous cohort of DTC patients.
  
  
  METHODS
  Patients included 366 consecutive patients with DTC who had all been treated according to the same protocol for initial therapy and follow-up.
  
  
  METHODS
  Prognostic factors for DTC-related death were analyzed by univariate Cox regression analysis, followed by stepwise multivariate Cox regression analysis. Standardized mortality rates (SMR) were calculated using normal mortality rates for the entire Dutch population.
  
  
  RESULTS
  During follow-up of 8.3 +/- 4.6 yr, 82 patients (22.4%) died. At multivariate Cox-regression analysis, tumor stage T4, distant metastases, and advanced age were associated with an increased relative risk for DTC-related death. SMR for the entire group was 2.32. This could be explained by increased SMR in patients with stage T4, distant metastases, or advanced age. Death causes could be verified in 80 patients: 52 died of DTC, 28 due to other causes. Ten of the 20 patients with stage T1-3M0 died from thyroid carcinoma.
  
  
  CONCLUSIONS
  Relative risk for thyroid cancer-related death and SMR are significantly increased in patients with stage T4 and M1 or advanced age. Although death risk is not increased in T1-3 M0 patients, DTC contributed significantly to mortality in all patient categories.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: Carmen F A
authors.initials: CF
authors.lastname: Eustatia-Rutten
authors.forename: Eleonora P M
authors.initials: EP
authors.lastname: Corssmit
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Smit
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality*; D002423:Cause of Death; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D013974:Thyroxine / Q000627:therapeutic use
chemical_list: D013954:Thyroglobulin; D013974:Thyroxine