Prognostic indices for tumor relapse and tumor mortality in follicular thyroid carcinoma

Abstract

To establish an objective basis for therapeutic decisions and follow-up programs in patients with follicular thyroid cancer, the authors developed a prognostic scoring system. The prognostic impact of nine clinical, histologic, and therapeutic parameters was quantified retrospectively based on a multivariate analysis covering 149 patients. The relative relapse risk in follicular thyroid cancer (RR) was 6.8-fold increased in the presence of a moderate when compared with a high degree of histologic tumor differentiation. The RR rose with increasing age of the patient at time of tumor diagnosis by a factor of 1.8 per 20 years. The RR was reduced by a factor of 4.3 after the performance of a neck dissection and by a factor of 2.3 after percutaneous radiation therapy of the neck. The relative mortality risk in follicular thyroid cancer (RM) rose in the absence of a tumor capsule by a factor of 10, in the presence of a moderate compared with a high degree of histologic tumor differentiation by a factor of 5.9, in the presence of distant metastases by a factor of 3.2, and with increasing age of the patient at the time of tumor diagnosis by a factor of 2.2 per 20 years. From these data prognostic indices denoting the individual risk for tumor relapse (IRR index) and tumor mortality (IMR index) were calculated. The indices categorize patients into low-risk, medium-risk, or high-risk groups with regard to tumor relapse and tumor-related death. Consequently, the IRR and IMR indices contribute to select patients with follicular thyroid cancer who need an aggressive form of treatment and an intensive followup program. The indices may also be used for risk stratification in prospective therapy trials. Cancer 67:1903Cancer 67: -1911Cancer 67: ,1991. Accepted for publication October 15, 1990. thyroid cancer runs a benign course when compared with other malignancies,* it decreases the quality of life or becomes fatal in a substantial percentage of patient^.^ It is our conviction and that of others'*4 that implementation of risk-oriented medical care in thyroid cancer based on objective criteria, as revealed by mathematical assessment of prognosis, will both improve prognosis and minimize unnecessary treatment. The mathematical assessment of individual prognosis in diseases has become possible with the development of multivariate rn~dels.~ These models determine prognostic factors and quantify their impact on prognosis. In addition, the models permit the calculation of prognostic indices. These indices determine the relapse or mortality risk of a patient as a function of the individual constellation of prognostic factors.Multivariate analyses of prognostic factors in thyroid cancer have recently been reviewed.6 Among these studies, 1903

Prevalence and Prognosis of Familial Follicular Thyroid Carcinoma

“…In our series, conventional prognostic factors such as poor differentiation, distant metastasis at diagnosis, patient age and large tumor size [1,[13][14][15][16][17][18][19][20] were recognized as having prognostic impact on univariate and/or multivariate analyses, indicating that our series of follicular carcinoma is suitable for statistical analysis. In this study, familial follicular carcinoma showed even better prognosis than sporadic follicular carcinoma, because none of these patients showed recurrence or died of follicular carcinoma.…”

“…Table 4 summarizes the clinicopathological features of familial and sporadic follicular carcinomas. There were no significant differences in gender, age, carcinoma differentiation, minimally or widely invasive, tumor size, distant metastasis at surgery, massive extrathyroid extension accounting for pT4a in the UICC TNM classification [13], and lymph node metastasis between FNMTC and sporadic follicular carcinoma. Although there was no significant difference, none of FNMTC patients were classified as having poorly differentiated carcinoma and none had distant metastasis at surgery, massive extrathyroid We then compared the prognoses of patients with FNMTC and sporadic follicular carcinoma.…”

Prognostic Factors and Therapeutic Strategies for Differentiated Carcinomas of the Thyroid

“…To date, several prognostic factors have been identified in Western countries; these include tumor size, distant metastasis at surgery, age, marked vascular invasion, Hurthle cell type, and male gender [94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109]. Ten-year CSS rates ranged from 43 to 80%, which tended to be worse than those of papillary carcinoma possibly because of the higher frequency of distant metastasis.…”

Prognostic factors of minimally invasive follicular thyroid carcinoma: Extensive vascular invasion significantly affects patient prognosis

“…Previous studies showed that widely invasive FTC displays a significantly poorer prognosis than minimally invasive FTC [4,5]. To date, other conventional prognostic factors of FTC such as distant metastasis at diagnosis (M1), old age, and large tumor size have also been identified [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. However, prognostic factors of minimally invasive FTC have not been intensively investigated and, to our knowledge, only one manuscript has been published for a large series of patients [23].…”