Summary In this study of papillary thyroid carcinomas, immunopositivity for EGF-receptor was present in a majority of the cases (96%), although different staining patterns were observed. A distinct membraneous reaction was found in 46%, whereas cytoplasmatic positivity of various degrees was present in 90% of the cases. Strong cytoplasmic EGF-receptor staining was significantly associated with extra-thyroidal growth of the primary tumour (P = 0.009), and it was furthermore related to decreased recurrence free survival (P = 0.006). Membraneous EGF-receptor staining was not associated with recurrence free survival or patient survival. Multivariate Cox analysis showed that lymph node metastases (P = 0.0009) and cytoplasmic EGFreceptor staining (P = 0.0048) was independent indicators of tumour recurrences in this group of surgically treated papillary thyroid carcinomas.The prognosis of patients with papillary thyroid carcinoma has previously been described in several reports (Byar et al., 1979; Tubiana et al., 1985;Carcangiu et al., 1985;Akslen et al., 1991), and the influence of sex, age and tumour stage has been discussed. In addition, certain pathological features such as marked nuclear atypia, necrosis or vascular invasion are also important (Tennvall et al., 1985;Schindler et al., 1991;Akslen et al., 1993). This information may improve the risk estimation for individual patients.In recent years, alterations in various growth factors and their receptors have been established as important features of the neoplastic process (Wynford-Thomas, 1991), among them epidermal growth factor (EGF) and its receptor (EGF-R). EGF is known to induce cell proliferation in several tissues, and its effect is mediated via a tyrosine kinase type of receptor (Carpenter & Cohen, 1979). It has previously been shown by different methods that EGF-receptors are expressed in papillary thyroid carcinomas (Duh et al., 1985;Lemoine et al., 1991;Mizukami et al., 1991; Mizukami et al., 1992), but the biological significance of this finding in terms of patient prognosis is not known. The purpose of the present study was therefore to perform a retrospective immunohistochemical study of EGF-R expression in a series of papillary thyroid carcinomas with special reference to its prognostic importance. Material and methodsPatients This material has been described previously . Briefly, all 263 patients who were surgically treated for thyroid cancer at the Department of Surgery, Haukeland Hospital, University of Bergen in the period 1971-1985 have been studied retrospectively. After histological revision and subtyping of the carcinomas according to the WHO criteria (Hedinger, 1988), 173 cases were found to be papillary carcinomas with a known primary tumour. One of the main results from our previous study was that very few events were observed in tumours with a diameter of 10 mm or below (microcarcinomas according to the WHO criteria). These were therefore excluded, thereby concentrating on clinically significant papillary carcinomas. Sufficient materia...

Summary This prospective study of 63,090 Norwegian women with 124 cases of thyroid cancer diagnosed during 1961 -1989 (McTiernan et al., 1984;Ron et al., 1987;Preston-Martin et al., 1987;Franceschi et al., 1990a). In autopsy studies, no significant sex and age contrasts in the frequency of occult microcarcinomas seem to be present (Fukunaga & Yatani, 1975) On the basis of the total number of cases included in any particular analysis, the expected number was found for each level of the study variable, assuming no association with cancer (Thomas & Gart, 1983 Times of death and emigration were taken into account in the calculation of expected numbers (Tarone, 1975). The analyses were adjusted for age at the start of follow-up (with 5-year age groups), county and in special cases other demographic and reproductive variables. The adjustments were made by forming a stratum for each combination of covariables. The analyses also produced two-tailed P-values for linear trend. Stratified logistic regression analyses were carried out according to the procedure described by Thomas and Gart (1983). In the estimation procedure, a correction for death and emigration was introduced by decreasing the initial number at risk by half the number of such events occurring among those who did not develop thyroid cancer. Due to missing values for certain reproductive variables, the number of cases varied somewhat between analyses. The majority of the women aged 49 years or less at the start of the follow-up were premenopausal at the time of interview. Consequently, the information on number of births will be incomplete for some participants in this age category. Therefore, in addition to the analyses that included all age groups, separate analyses were performed based on the participants aged 49 years or less and those aged 50 or more at the start of follow-up. Separate analyses were also carried out in subgroups according to age at diagnosis, < 54, 55-69, >70 years. Table I shows the distribution of cases according to demographic variables. The risk of thyroid cancer was highest in the counties of Aust-Agder and Tr0ndelag, whereas no urban/rural gradient was observed. Increased risk was observed in the occupational category fishing, ships officers, crew (odds ratio estimate, based on stratified logistic regression: 2.14, 95% CI: 1.30-3.54 for the total series). Results Demographic factors

Glomeruloid microvascular proliferation (GMP) in breast cancer independently adversely affected survival (relative risk 1.9, 95% CI: 1.2 -3.0), particularly among women who received adjuvant chemotherapy (10-year survival 27 vs 69%, P ¼ 0.0003), and was significantly associated with p53 overexpression and BRCA1 germline mutations. The presence of GMP may influence treatment decisions.

Summary Survival (5-and 10-year) and prognostic factors of all differentiated thyroid cancer patients (n= 1,055) occurring in Norway in 1970-79 are presented. The multivariate analysis (GLIM) revealed that stage and age were the only significant prognostic factors. Sex and histological type could not be proved to be of major prognostic value. The decline in relative survival with age was different in the three stages, appearing as a continuous decrease in stage 3, while in stage 1 the decrease was present only in patients older than 75 years.

Summary The relationship between thyroid cancer in women and the occupation of their spouses was examined in a retrospective cohort study, with special reference to fishery. Of the 2.9 million women registered in the Central Population Registry of Norway on 31 December 1991, 1.2 million women had a spouse registered with an occupation in one or more of the censuses in 1960, 1970 or 1980. The women were assigned to ten broad categories based on the first digit of their husbands five-digit Nordic occupational classification code NYK, and a standardized incidence ratio (SIR) was calculated for each occupational category. The women were further subdivided and analysed in 71 groups defined by the first two digits of the NYK code. Among the women included in the study, a total of 2409 cases of thyroid cancer were reported to the cancer registry of Norway during 1960-92. A significantly elevated risk of thyroid cancer was found only among women whose spouses belonged to the occupational category 'agriculture, forestry or fishery' (n = 208 279), with a SIR of 1.13. In the group associated with 'fishing, whaling and sealing work' (n = 40 839), the risk was further increased (SIR 1.91, Cl 1.65-2.21). An increased risk was also detected in the group associated with 'ship officers and pilots work' (n= 29 133) (SIR 1.35, Cl 1.07-1.67). When allocating the women to southern and northern cohorts determined by their county of birth, a difference in risk was clearly present in all 10 occupational categories, with figures being 50-60% higher in the north. However, there was practically no difference in incidence between northern and southern cohorts among women associated with fishery work. Thus, the results obtained from this study indicate that being a fisherman's wife is associated with elevated risk of thyroid cancer, and our data support the suggested role of seafood as an aetiological factor.