Prognostic Factors in Papillary Thyroid Cancer: An Evaluation of 601 Consecutive Patients

Abstract

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.

A Radiation-Induced Gene Signature Distinguishes Post-Chernobyl from Sporadic Papillary Thyroid Cancers

“…Increased serum concentrations of VEGF-A and EGFR protein were also reported in PTC (36,39), eventually inducing systemic effects. It is interesting to note that increased levels were especially linked with PTC characterized by lymph node metastases and more aggressive behavior (40) and patients over the age of 45 (41). Again, post-Chernobyl PTC appeared more aggressive at presentation with lymph node metastasis (60-80%); other extrathyroidal spread and venous invasion were commonly observed (11)(12)(13).…”

A new functional parameter measured at the time of ablation that can be used to predict differentiated thyroid cancer recurrence during follow-up

“…Haq et al (17) reported a comparable age of 70 years and older in relation to a poor outcome. Both Volante et al (19) and Siironen et al (20) described an age of O45 years in close relation to an aggressive tumor behavior. Based on the present data, however, it can be concluded that age at initial diagnosis is indicative for tumor extension, but it is not an independent prognostic parameter that can be used to identify patients with a high risk for tumor recurrence.…”

Correlation of KI-67/MIB-1 in the Papillary Macro and Micro-carcinomas of the Thyroid Gland with the Prognosis of the Patients

“…The reviews of the morphologic findings are not able to predict the tumor policy and aggressive behavior. The more advanced methods of the growth of tumors are not only useful to foresee the biological behavior of the tumor cells, rather they help to choose a better way to cure and pursuit patients (Ito et al, 2010;Siironen et al, 2005). The significance of this subject will be more appear when it is about those patients who are selected from the dangerous group of intensity and process of malignancy and needs to a particular pursuit and attention (Ito et al, 2010).…”

“…In contrast, the risk factors in the affected groups which are based on the clinical and pathological criteria, give the important information about prognosis (Siironen et al, 2005;Theoharis et al, 2012). The factors affecting on the prognosis of the patients that have been studied include age, tumor size, lymph node invasion, capsule invasion, vascular invasion and distant metastases (Siironen et al, 2005;Theoharis et al, 2012). In some studies the micro carcinoma is defined as tumor size less than 1 cm in greatest diameter (Theoharis et al, 2012).…”

“…In spite of the fact the index of the Ki-67 cell marker (ki-67 labeling index = LI) for the diagnosis of thyroid neoplasms has been studied but the relationship between the papillary thyroid carcinoma and the ki-67 LI and the biological behavior is not well understood (Lim et al, 2007;Pujani et al, 2010). Some studies conducted on patients with the PTMC with the high ki-67 LI levels, obviously demonstrated that they had the lower disease-free survival and higher rates of the disease recurrence, compared with the PTMC and PTC (macro carcinoma) with Low Ki-67 LI (Hay et al, 1992;Siironen et al, 2005).…”