Differentiated thyroid cancer in a Swedish county--long-term results and quality of life.
BACKGROUND
There is still no complete agreement about the proper treatment of differentiated thyroid cancer (DTC).


METHODS
All patients (n=130) with DTC in a defined population, treated with surgery between 1985 and 1999, were carefully followed up (median 13.1 years). Fifty three were operated with subtotal and 77 with total thyroidectomy. Twenty seven percent of the patients in the subtotal group and 56% of those in the total thyroidectomy group had postoperative radioiodine ablation. Thirty nine patients had papillary cancers incidentally detected during surgery for benign disorders (median size 7 (1-30) mm). Living patients answered the Swedish version of the SF-36 health survey.


RESULTS
Eleven of 106 patients considered tumour-free after primary surgery developed recurrences during follow-up. Fifteen patients (12%) died from DTC but only one within stage I-II (1.2%). No patient below 50 years of age at diagnosis died from DTC. Only three of 29 patients with isolated loco-regional spreading of their disease at the time of diagnosis have died from thyroid cancer. There was no statistically significant difference in the 10 year cancer-specific survival rate between those operated with subtotal or total thyroidectomy--irrespective of stage. Survival rate was significantly better for papillary than for follicular cancer. Mental and physical quality of life among patients treated for DTC were similar to the healthy Swedish population.


CONCLUSIONS
Patients with DTC stage I-II (according to TNM) or low-risk (according to AMES) have an excellent prognosis. Treatment as well as follow-up should not be exaggerated.
Malterling
Rebecka R
RR
Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
Andersson
Roland E
RE
Falkmer
Sture
S
Falkmer
Ursula
U
Niléhn
Eva
E
Järhult
Johannes
J
D018263:Adenocarcinoma, Follicular / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012042:Registries; D018401:Sample Size; D013548:Sweden / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D007457:Iodine Radioisotopes