Naslov
Analysis of prognostic factors of thyroid cancers in patients with distant metastases

Autori
Bence-Žigman, Zdenka ; Dodig, Damir ; Žigman, Tomislav ; Žarković, Tamara

Izvornik
European journal of nuclear medicine and molecular imaging (1619-7070) 31(2) (2004);

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, kongresno priopcenje, znanstveni

Ključne riječi
Thyroid cancers

Sažetak
Introduction: the treatment of patients with thyroid cancer (TC), especially papillary is still controversial. Ultrasound and guided cytology can detect very small cancers, with this, the treatment of such a patients is even more controversial. Aim: the main idea of this work was to point out that early detection of TC and initial treatment play the most important role on final outcome. Material: The 698 patients, 590 female and 108 male (5, 4:1) with TC (557 papillary, 89 follicular, 13 Hürthle cell, 38 medullary and 1 anaplastic), aged from 3 to 78 years (mean 46, 3&plusmn ; 13, 7) were followed-up for the periods ranging from 0, 5 to 37 years (mean 6, 6&plusmn ; 6). Results: In 43 patients (6, 2% of the 698 patients), aged 6 to 76 years (mean 46, 4&plusmn ; 19, 1), distant metastases (DM) were observed, 29 female and 14 male (2:1, vs. 6:1 in the group without DM). Among them there were 60% of papillary, 30% of follicular, 7% of medullary and 2% of anaplastic carcinomas. 14% of patients were younger than 21 years, 35% were younger than 45 years, and 51% were older than 45 years, vs. 3%, 38%, and 59 % in the group without DM. 79 % of patients with DM had also lymph node metastases and 42% had intraglandular dissemination vs. 23, 8%, and 24, 6% respectively, in the group without DM. Patients with DM had larger primary tumors (4, 1&plusmn ; 2, 8 cm, vs. 1, 8&plusmn ; 1, 5 cm in the group without DM), frequently with extrathyroidal extension. The 39 (91% of patients with DM) have been treated with 131I (3, 7 to 11, 1 GBq), and 27 (69%) required repeated doses. In 11 patients (28%) complete remission, without evidence of DM, was observed, and 15 patients (35% of the 43 patients with DM) died during the period of follow-up. Conclusion: Although the most of the patients with TC have good prognosis, patients with DM have poor prognosis. Now, we have tools for the detection of very small cancers and very small metastatic lymph nodes, but still don't have the tools to predict biological behaviour of TC. Based on these observation we plead for total thyroidectomy even when small TC are diagnosed, dissection of metastatic lymph nodes if they are diagnosed by ultrasonically guided fine needle biopsy, and radioiodine ablation of thyroid remnant, because the early detection and initial treatment is the most important on the final outcome.

Izvorni jezik
Engleski

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