title: Operative strategy for follicular thyroid cancer in risk groups stratified by pTNM staging.
abstract: This study determined cancer survival rates and follow-up status at different pTNM stages to stratify risk groups in follicular thyroid carcinoma. Two hundred and fourteen follicular thyroid cancer patients (167 females, 47 males) who underwent surgery and followed-up treatment at a single medical center were enrolled in this retrospective study. Tumors were staged by UICC-TNM criteria (6th edition). Low risk for follicular thyroid cancer was defined as pT1N0M0. (Moderate-risk group) was defined as all other patients in pTNM stage I, and high risk as patients in stages II-IV. After mean follow-up of 9.6+/-0.3 years, 1.6% (2/120), 21.9% (7/32), 5.6% (1/18) and 52.3% (23/44) of patients in pTNM stages I-IV, respectively, died of thyroid cancer. Of 214 follicular thyroid cancer patients, 35 (16.4%), 85 (39.7%) and 94 (43.9%) were defined as low-, moderate- and high-risk groups at the time of surgery. None of the low-risk patients died, and all achieved disease-free status. In the moderate- and high-risk groups, 2.4% (2/85) and 27.7% (26/94) died of thyroid cancer. The moderate- and high-risk groups underwent near-total thyroidectomy and (131)I therapies, and 15 of 107 (14.9%) died of thyroid cancer while 18 (16.8%) had persistent disease at the end of the study period. Multiple regression analysis demonstrated that tumor size, radioactive iodide therapy and post-operative thyroglobulin level significantly differ between the mortality and survival groups. In conclusion, the low-risk follicular thyroid cancer group as defined by pTNM staging had excellent prognosis. Total thyroidectomy and post-operative radioactive iodide therapy are mandatory in moderate- and high-risk groups. Over one-fourth of the follicular thyroid cancer patients in the high-risk group died of thyroid cancer despite aggressive treatment.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, ROC. einjd@adm.cgmh.org.tw
authors.forename: Jen-Der
authors.initials: JD
authors.lastname: Lin
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.forename: Szu-Tah
authors.initials: ST
authors.lastname: Chen
authors.forename: Yu-Yao
authors.initials: YY
authors.lastname: Huang
authors.forename: Miaw-Jene
authors.initials: MJ
authors.lastname: Liou
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin