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He LY, Wang WW, Ibrahima BA, Han S, Li Z, Cai Z, Chen ML, Chen BZ, Tan HS, Zeng HS, Dai XL, Zhou MW, Zhang GQ, Li GX. The prognostic value of regional lymph node metastases in patients of Guangdong Province, China with differentiated thyroid cancer: A multicenter retrospective clinical study. Medicine (Baltimore) 2016; 95:e5034. [PMID: 27741112 PMCID: PMC5072939 DOI: 10.1097/md.0000000000005034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although the prognostic value of nodal metastases in differentiated thyroid cancer remains controversial, it is of interest to evaluate and understand the different characteristics of predictive outcomes.A multicenter retrospective study was conducted in 215 untreated patients with differentiated thyroid cancer from July 1997 to July 2015 in 4 medical centers of Guangdong Province. A total of 107 patients with nodal metastases (group A) were compared to 108 patients without metastases (group B). The 5-year disease-free survival (DFS), overall survival (OS), and postoperative complications in both groups were calculated. Variables predictive of DFS and OS were evaluated in group A.The group A had lower 5-year DFS (69.16%, 11 months) and shorter median time of recurrence than those in group B (87.96%, 8.5 months, respectively, P < 0.001). The incidence of temporary hypoparathyroidism in group A is lower; whereas higher incidence of temporary unilateral vocal cord palsy, permanent hypoparathyroidism, permanent unilateral vocal cord palsy, and bilateral vocal cord palsy in group A were observed. Both univariate and multivariate analyses in group A revealed that age, pathological tumor node metastasis (pTNM) stage, and histology were related to DFS (P < 0.05); while pTNM stage and histology were related to OS only in univariate analyses.Positive nodal metastases have significant prognostic value in patients with differentiated thyroid cancer in Guangdong, China and primarily reduce DFS. Moreover, patients with positive nodal metastases who are >45 years and have higher pTNM stage or follicular histology tend to have poor prognosis. Selective lymph node dissection with appropriate postoperative treatment and frequent follow-up should be accorded to these vulnerable groups of patients.
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Affiliation(s)
- Lin-yun He
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wei-wei Wang
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Balde Alpha Ibrahima
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Shuai Han
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhou Li
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
- Correspondence: Zhou Li, Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China (e-mail: )
| | - Zhai Cai
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Miao-liang Chen
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bao-zhu Chen
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hui-shi Tan
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hai-shan Zeng
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xiao-li Dai
- Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Min-wei Zhou
- General Hospital of Guangzhou Military Command of PLA
| | - Gang-qing Zhang
- Guangdong No. 2 Provincial People's Hospital, Guangzhou, Guangdong Province, China
| | - Guo-xin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Gulcelik M, Ozdemir Y, Kadri Colakoglu M, Camlibel M, Alagol H. Prognostic factors determining survival in patients with node positive differentiated thyroid cancer: a retrospective cross-sectional study. Clin Otolaryngol 2012; 37:460-7. [DOI: 10.1111/coa.12022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 11/30/2022]
Affiliation(s)
- M.A. Gulcelik
- Department of Surgery; Ankara Oncology Hospital; Ankara; Turkey
| | - Y. Ozdemir
- Department of Surgery; Ankara Oncology Hospital; Ankara; Turkey
| | | | - M. Camlibel
- Department of Surgery; Ankara Oncology Hospital; Ankara; Turkey
| | - H. Alagol
- Department of Surgery; Ankara Oncology Hospital; Ankara; Turkey
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Ito Y, Masuoka H, Fukushima M, Inoue H, Kihara M, Tomoda C, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Miyauchi A. Prognosis and prognostic factors of patients with papillary carcinoma showing distant metastasis at surgery (M1 patients) in Japan. Endocr J 2010; 57:523-31. [PMID: 20379035 DOI: 10.1507/endocrj.k10e-019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Distant metastasis (DM) at surgery is a prominent prognostic factor in patients with papillary carcinoma of the thyroid. However, the clinical outcomes of these patients (M1 patients) remain unclear. In this study, we investigated the prognosis and prognostic factors of M1 patients. Seventy-one of 5969 patients who underwent initial surgery in Kuma Hospital between 1987 and 2004 were classified as M1 and enrolled in this study. Five-year and 10-year cause specific survival (CSS) rates were 78.8 +/- 5.2% and 76.3 +/- 5.7%, respectively. Patients aged 55 years or older, having tumor larger than 4 cm, massive extrathyroid extension to adjacent organs other than the recurrent laryngeal nerve and cricothyroid or inferior constrictor muscle, and DM to organs other than the lung showed a significantly worse CSS on univariate analysis. On multivariate analysis, the first three parameters were recognized as independent prognostic factors for M1 patients. Patients who underwent locally curative surgery, having DM showing radioactive iodine (RAI) uptake, and who underwent thyroid stimulation hormone (TSH) suppression therapy showed a better CSS rates than those who underwent only palliative surgery, having DM without RAI uptake, and who did not undergo TSH suppression therapy, although there was no significant difference in CSS between these groups. These findings suggest that evaluation of preoperative and intra-operative findings is important to predict the prognosis of M1 patients, the same as that in patients without DM. Locally curative surgery, RAI therapy, and TSH suppression therapy are actively recommended for M1 patients when conditions permit.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe City, Japan.
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Papillary thyroid carcinoma with distant metastases: survival predictors and the importance of local control. Surgery 2007; 143:35-42. [PMID: 18154931 DOI: 10.1016/j.surg.2007.06.011] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 05/31/2007] [Accepted: 06/05/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of distant metastases is the most important predictive factor of poor outcomes in patients with papillary thyroid carcinoma (PTC). Some patients have very slow-growing distant metastases with relatively favorable outcomes, so predicting prognosis is not easy. Furthermore, many patients with distant metastases show locally advanced disease, and no consensus is available for operative control of cervical tumor in this situation. METHODS Among 1023 patients with PTC who underwent primary thyroidectomy from 1976 to 2002, 42 patients displayed distant metastases at initial presentation and 44 patients developed distant metastases during follow-up. We reviewed the records retrospectively of these 86 patients. Mean duration of follow-up after detection of distant metastases was 7 years. Our treatment approach for patients with locally advanced neoplasms was radical resection including extensive neck dissection and extended resection of the involved organs, even when distant metastases were present. RESULTS Disease-specific survival of the 86 patients with distant metastases at 5 and 10 years was 65% and 45%, respectively. Using multivariate analysis, older age at time of distant metastases detection, distant metastases involving sites other than the lung, distant metastases diameter > or = 2 cm, presence of large nodal metastases (> or = 3 cm), and a primary neoplasm with poorly differentiated components were all predictive of worse prognosis. Our aggressive approach allowed curative resection in all but 1 patient, and only 5 patients (6%) succumbed to local disease. Patients with cervical recurrences displayed worse prognosis than those without. CONCLUSIONS Although the currently employed modalities of therapy for distant metastases do not have definitive impact on survival, some PTC patients with distant metastases, including younger patients with well-differentiated, small lung metastases appear to have relatively favorable outcomes. Local operative control of PTC is important even in patients with distant metastases, particularly when the distant metastases appear to be slow-growing.
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Sugino K, Kure Y, Iwasaki H, Ozaki O, Mimura T, Matsumoto A, Ito K. Metastases to the regional lymph nodes, lymph node recurrence, and distant metastases in nonadvanced papillary thyroid carcinoma. Surg Today 1995; 25:324-8. [PMID: 7633123 DOI: 10.1007/bf00311254] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To investigate the biological characteristics of papillary thyroid carcinoma from the perspectives of lymph node metastasis, lymph node recurrence, and distant metastasis, 746 patients with nonadvanced papillary thyroid carcinoma were retrospectively studied. There were 76 men and 670 women with a mean age of 42.7 years. The rate of lymph node metastasis was significantly higher in young patients (aged less than 30 years). Lymph node recurrence was observed in 80 patients and distant metastasis in 13, being seen with significant frequency in the young and elderly (aged over 50 years) patients and in the men. The frequency of distant metastasis was significantly greater in the elderly patients and in those with lymph node recurrence. These findings indicate that the role of regional lymph nodes and the clinical meaning of lymph node recurrence differ between young and elderly patients.
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