Abstract
Purpose
Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). They have different biological behavior but are frequently analyzed together in studies. We aimed to identify factors associated with mortality in those two different cancer subtypes.
Methods
Case series study, with clinical–pathological analysis of the characteristics of 424 patients with PTC and 89 patients with FTC, correlating them to survival rates in a single institution.
Results
Patients were followed from 1983 to 2011. Mean follow-up time was 9.4 years for FTC (range 1–36.6 years) and 6.8 years for PTC (range 1.1–30.7 years). Mean age at diagnosis was 51.2 ± 15.5 for FTC and 41 ± 14.7 years for PTC. 50.62 % of FTC nodules sized 1.1–4 cm and 20 % of PTC sized ≤1 cm. Cox multiple regression analysis evidenced distant metastasis at diagnosis (p = 0.0038; relative risk (RR) 41.247, 95 % confidence interval (CI) 3.317–512.986), lymph node metastasis at diagnosis (p = 0.0081; RR 50.98, 95 % CI 2.783–934.026) and vascular/lymphatic invasion (p = 0.0039; RR 40.424, 95 % CI 3.287–497.177) as factors related to mortality in FTC patients. For PTC, the factors were distant metastasis at diagnosis (p < 0.0001; RR 32.5, 95 % CI 6.676–158.543) and degree of differentiation (poor versus well differentiated, p = 0.003; RR 10.4, 95 % CI 2.218–49.487).
Conclusion
The common factor that influenced mortality for FTC and PTC patients was distant metastasis at diagnosis, increasing mortality rate by 41 times in FTC and 30 times in PTC patients. The different factors influencing mortality for different DTC types highlight the importance of analyzing them separately.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59(4):225–249
Chen AY, Jemal A, Ward EM (2009) Increasing incidence of differentiated thyroid cancer in the United States, 1988–2005. Cancer 115(16):3801–3807
Welker MJ, Orlov D (2003) Thyroid nodules. Am Fam Physician 67(3):559–566
Lang BH, Wong KP, Cheung CY, Wan KY, Lo CY (2013) Evaluating the prognostic factors associated with cancer-specific survival of differentiated thyroid carcinoma presenting with distant metastasis. Ann Surg Oncol 20(4):1329–1335
Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428
Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, Ordonez NG (1992) Well-differentiated thyroid carcinoma and the results of various modalities of treatment: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720
Brierley J, Tsang R, Panzarella T, Bana N (2005) Prognostic factors and the effect of treatment with radioactive iodine and external beam radiation on patients with differentiated thyroid cancer seen at a single institution over 40 years. Clin Endocrinol (Oxf) 63:418–427
Lerch H, Schober O, Kuwert T, Saur HB (1997) Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol 15:2067–2075
Loh KC, Greenspan FS, Gee I, Miller TR, Yeo PP (1997) Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. J Clin Endocrinol Metab 82:3553–3562
Lang BH, Lo CY, Chan WF, Lam KY, Wan KY (2007) Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg 245:366–378
Lang BH, Lo CY, Chan WF, Lam KY, Wan KY (2007) Prognostic factors in papillary and follicular thyroid carcinoma: implications for cancer staging. Ann Surg Oncol 14:730–738
Lee J, Soh EY (2010) Differentiated thyroid carcinoma presenting with distant metastasis at initial diagnosis: clinical outcomes and prognostic factors. Ann Surg 251:114–119
Klein Hesselink EN, Klein Hesselink MS, de Bock GH, Gansevoort RT, Bakker SJ, Vredeveld EJ, van der Horst-Schrivers AN, van der Horst IC, Kamphuisen PW, Plukker JT, Links TP, Lefrandt JD (2013) Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma: an observational study. J Clin Oncol 31(32):4046–4053
Blesa JMG, Pulido EG, Pulla MP, Candel VA, Canales JBL, Arrom MG, Rico PM (2010) Old and new insights in the treatment of thyroid carcinoma. J Thyroid Res. doi:10.4061/2010/279468
Czarniecka A, Jarzab M, Krajewska J, Chmielik E, Szcześniak-Klusek B, Stobiecka E, Kokot R, Sacher A, Poltorak S, Wloch J (2010) Prognostic value of lymph node metastases of differentiated thyroid cancer (DTC) according to the local advancement and range of surgical excision. Thyroid Res. doi:10.1186/1756-6614-3-8
Zhao Y, Zhang Y, Liu XJ, Shi BY (2012) Prognostic factors for differentiated thyroid carcinoma and review of the literature. Tumori. 98(2):233–237
Lin JD, Liou MJ, Chao TC, Weng HF, Ho YS (1999) Prognostic variables of papillary and follicular thyroid carcinoma patients with lymph node metastases and without distant metastases. Endocr Relat Cancer 6(1):109–115
Sugino K, Ito K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, Yano Y, Uruno T, Akaishi J, Kameyama K, Ito K (2011) Prognosis and prognostic factors for distant metastases and tumor mortality in follicular thyroid carcinoma. Thyroid 21(7):751–757
Nowak W, Szybiński P, Nowak K, Stachura J, Popiela T (2004) Prognostic factors influencing survival after surgical treatment of well differentiated thyroid cancer. Wiad Lek 57(9–10):431–437
Ibrahimpasic T, Ghossein R, Carlson DL, Nixon I, Palmer FL, Shaha AR, Patel SG, Tuttle RM, Shah JP, Ganly I (2014) Outcomes in patients with poorly differentiated thyroid carcinoma. J Clin Endocrinol Metab 99(4):1245–1252
Lo CY, Chan WF, Lam KY, Wan KY (2005) Follicular thyroid carcinoma: the role of histology and staging systems in predicting survival. Ann Surg 242(5):708–715
D’Avanzo A, Treseler P, Ituarte PH, Wong M, Streja L, Greenspan FS, Siperstein AE, Duh QY, Clark OH (2004) Follicular thyroid carcinoma: histology and prognosis. Cancer 100(6):1123–1129
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19(11):1167–1214
Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295(18):2164–2167
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Melo, T.G., Zantut-Wittmann, D.E., Ficher, E. et al. Factors related to mortality in patients with papillary and follicular thyroid cancer in long-term follow-up. J Endocrinol Invest 37, 1195–1200 (2014). https://doi.org/10.1007/s40618-014-0131-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-014-0131-4