Abstract
The relative importance of prognostic factors in papillary and follicular thyroid cancer was studied in 113 patients using Cox's proportional hazards model. Prognostic factors studied were: histology, tumor grade, extrathyroidal growth, nodal involvement, distant métastases at diagnosis, nuclear DNA content, age at diagnosis, and sex. Nuclear DNA content was measured in primary tumors by flow cytometry. Total thyroidectomy and postoperative131I ablation was the standard treatment. The results showed that nuclear DNA content correlated significantly with histologic type and, in papillary cancer, also with tumor grade. The presence of distant metastases at diagnosis was, by far, the most important prognostic factor. In the patient group without distant metastases (n=91), multiploidy (i.e., presence of 2 or more aberrant stemlines) was the only significant prognostic factor for overall survival. With respect to diseasefree survival, multiploidy was second only to the age factor. In the patient group with distant métastases (n=22), all 6 patients with multiploid tumors died compared to 8 (50%) of 16 of those with other ploidy tumors. However, the small number in this group precluded significant results. The present study demonstrates that nuclear DNA content is a prognostic factor in those patients with papillary and follicular thyroid cancer without distant metastases at diagnosis.
Résumé
L'importance relative des facteurs pronostiques dans les cancers papillaires et folliculaires de la thyroïde ont été étudiés chez 113 patients selon le modèle de Cox. Voici les facteurs de pronostic étudiés: histologie, degré de différentiation, extension extrathyroïdienne, envahissement ganglionnaire, présence de métastase à distance au moment du diagnostic, contenu nucléaire en ADN, âge au moment du diagnostic, et sexe. Le contenu d'ADN nucléaire était mesuré dans les tumeurs primitives par la cytométrie de flux. La thyroïdectomie totale suivie d'I 131 était le traitement standard. Les résultats montraient que le contenu nucléaire en ADN était en corrélation significative avec le type histologique et le degré de malignité dans les cancers papillaires. La présence de métastases à distance était de loin le facteur pronostique le plus important. Dans le groupe de patients sans métastases (n=91), la présence de polyploïdie (c'est-à-dire 2 chaînes aberrantes ou plus) était le facteur pronostique significatif pour la survie globale. Pour la survie sans maladie, la polyploïdie venait après le facteur âge. Dans le groupe présentant des métastases à distance (n=22), tous les patients avec tumeurs polyploïdes sont morts pour huit patients de ceux qui avaient des tumeurs à ploïdie différente. Mais le petit nombre de patients de ce groupe interdit de considérer ces résultats comme significatifs. Cette étude démontre que le contenu nucléaire en ADN est un facteur pronostique chez les patients ayant un cancer papillaire et folliculaire sans métastases au moment du diagnostic.
Resumen
La importancia relativa de los factores de pronóstico en el cancer papilar y folicular de la glándula tiroides fue estudiada en 113 pacientes utilizando el modelo de riesgos proporcionales de Cox. Los factores de pronóstico analizados fueron: histologia, grado tumoral, crecimiento extratiroideo, extension ganglionar, metastasis distantes en el momento del diagnóstico, contenido nuclear de DNA, edad en el momento del diagnóstico, y sexo. El contenido nuclear de DNA fue determinado en tumores primarios mediante citometn'a de flujo. El tratamiento estandar fue la tiroidectomía total y la ablación postoperatoria con131I. Los resultados muestran que el contenido nuclear de DNA se correlaciona en forma significativa con el tipo histológico y en el cancer papilar también con el grado tumoral. La presencia de metastasis distantes en el momento del diagnóstico es, muy ampliamente, el más importante factor de pronóstico. En el grupo de pacientes libre de metastasis distantes (n=91), la multiploidia (i.e., presencia de 2 o más lineas primitivas aberrantes) aparece como el único factor de significatión en cuanto a supervivencia global. Respecto a supervivencia libre de enfermedad la multiploidia aparece como segundo factor, después de la edad. En el grupo de pacientes con metástasis distantes (n=22) todos los 6 pacientes con tumores multiploides murieron, en comparación con 8 (50%) de 16 de aquellos con tumores con cualquier otro tipo de ploidia. Sinembargo, el pequeno número que constituye este grupo impide derivar resultados de signification. El presente estudio demuestra que el contenido nuclear de DNA es un factor pronóstico en pacientes con cancer tiroideo papilar y folicular libres de metastasis distantes.
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Hamming, J.F., Schelfhout, L.J.D.M., Cornelisse, C.J. et al. Prognostic value of nuclear DNA content in papillary and follicular thyroid cancer. World J. Surg. 12, 503–507 (1988). https://doi.org/10.1007/BF01655433
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DOI: https://doi.org/10.1007/BF01655433