Background: Although papillary thyroid cancer (PTC) is among the most curable cancer types, it can be a distressing disease for those patients suffering from frequent recurrences or even distant metastases leading to death. Age over 45 years is the most important indicator of poor prognosis. Our aim was to evaluate markers which might predict the outcome of an individual patient better than does TNM classification alone. Materials and Methods: Of 601 consecutive patients who underwent surgery for PTC, retrospectively we selected 36 patient pairs in which one recovered completely after primary surgery, and the other suffered from aggressive disease. Formalin-fixed, paraffin-embedded tumor samples from these 72 patients were analyzed by immunohistochemistry for COX-2, MMP-2, VEGF-C, Bcl-2, Ki-67, and p21 expression. Results and Conclusions: None of the markers we studied showed a superiority over TNM classification in selecting patients likely to progress to aggressive disease. However, the expression of COX-2 and VEGF-C seemed to be increased in patients over 45, which could explain the more aggressive behavior of these tumors. Moreover, we found that age over 45, tumor size over 4 cm, extrathyroidal extension of tumor, nodal metastases, distant metastases, and stage IV had an unfavorable effect on survival.

Anaplastic thyroid carcinoma (ATC) is one of the most lethal malignancies; poorly differentiated thyroid carcinoma (PDTC) is a new diagnosis for rare aggressive thyroid tumours. Surgery is often considered the only chance for survival, but the benefit of surgery and subsequent multimodal therapy is unclear. We retrospectively analyzed the outcome of 44 ATC and 8 PDTC consecutive patients treated at Helsinki University Central Hospital between 1990 and 2008. All ATC and PDTC cases were re-examined and reclassified histologically. Median survival was only 3.1 months for ATC, but 3.7 years for PDTC. Most patients in both groups eventually died of cancer. ATC patients were older than PDTC patients (74 vs. 66 years). Nodal and distant metastases had a negative impact on survival (ATC; p = 0.038, p = 0.008). Long-term survivors in both groups were stage N0M0 at presentation. Multimodal therapy was successful for 9 (20%) ATC patients, and their median survival was the longest (11.6 months) among treatment groups. Most PDTC patients (88%) underwent total thyroidectomy followed by radioiodine ablation; the only 2 who received chemotherapy survived longest. Although ATC and PDTC are both aggressive thyroid carcinomas, multimodal therapy for both can provide a chance of prolonged survival in patients with locoregional disease.

Our study shows that COX-2 expression increases with age. It is possible that the age-related increase in COX-2 expression could explain the more aggressive behaviour of PTC in the older age group compared with the young one.

In papillary thyroid cancer