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Classification of papillary cancer of the thyroid based on prognosis

  • International Association of Endocrine Surgeons—Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993
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Abstract

Between 1965 and 1988 there were 2953 patients with papillary carcinoma treated at Noguchi Thyroid Clinic. Among them 761 patients were excluded because the primary tumor was <10 mm in maximum diameter, the patient's age was >80, or the patient underwent noncurative surgery. The remaining 2192 patients, 192 men and 2000 women, were analyzed. The mean follow-up period was 12.5 years. Total thyroidectomy, subtotal thyroidectomy, lobectomy with or without isthmectomy, and less than lobectomy were performed in 2.3%, 40.3%, 44.2%, and 13.2%, respectively. Modified radical neck dissection, partial node excision, and no node excision were performed in 77.8%, 6.4%, and 15.8%, respectively. Men and women were separately analyzed because their risk factors and prognosis were significantly different. Multivariate analysis was carried out according to Cox's regression hazard model. Independently significant factors affecting prognosis in men were aged and gross nodal metastasis; and age, gross nodal metastasis,tumor size, and number of adhered tissues or organs were the factors in women. Based on those risk factors patients were classified into three groups. For men, 65.6% were classified in the excellent group and their 10-year survival was 98.4%; 17.2% were classified as intermediate and 17.2% as poor with survival rates of 90.1% and 74.4%, respectively. For female patients 69.6% were classified in the excellent group, 18.6% in the intermediate group, and 11.9% in the poor group with 10-year survivals of 99.3%, 96.4%, and 88.8%, respectively.

Résumé

Entre 1965 et 1988, 2953 patients ayant un cancer papillaire de la thyroïde ont été opérés à la Clinique Noguchi. Parmi ceux-ci, il y avait 761 cas où soit la tumeur primitive était inférieure à 10 mm de diamètre, soit le patient était âgé de plus de 80 ans ou encore avait eu une chirurgie non curative: ceux-là n'ont pas été étudiés ici. Parmi les 2192 autres, 2000 femmes et 192 hommes, le suivi moyen a été de 12.5 ans. Une thyroïdectomie totale, subtotale, une lobectomie enlevant aussi l'isthme ou pas et une exérèse partielle d'un lobe ont été effectuée dans 2.3%, 40.3%, 44.2%, et 13.2% des cas, respectivement. Un curage cervical, une lymphadenectomie partielle ou aucune lymphadenectomie cervicale a été pratiqué dans respectivement 77.8%, 8.4% et 15.8% des cas Les hommes et les femmes ont été analysés séparément en raison de leur facteurs de risque et facteurs pronostiques très différents. L'analyse multifactorielle a été menée selon le modèle de Cox. Les facteurs indépendants influencant de façon significative le pronostic ont été l'âge et les métastases macroscopiques chez l'homme, l'âge, les métastases macroscopiques, la taille de la tumeur et nombres de organes adhérents à la tumeur chez la femme. En se basant sur ces données, les patients ont été classés en trois groupes. 65.6% des hommes ont été classés dans le groupe “pronostic excellent”: leur survie à 10 ans était de 98.4%. 17.2% ont été classés comme “pronostic intermédiaire” et 17.2% comme “pronostic mauvais” avec des survies à 10 ans de 90.1% et de 74.4%, respectivement. Les chiffres pour la femme ont été, respectivement, de 99.3%, 96.4% et 88.8%.

Resumen

Entre 1965 y 1988, 2.953 pacientes con carcinoma papilar fueron tratados en la Clínica de Tiroides de Noguchi. De éstos, 761 fueron excluídos porque el tumor primario era menor de 10 mm en su diámetro máximo, porque su edad era superior a los 80 años o por haber recibido cirugía no curativa; los 2.192 pacientes restantes—192 hombres y 2.000 mujeres-fueron estudiados. El promedio del seguimiento fue 12.5 años. Se practicó tiroidectomía total, tiroidectomía subtotal, lobectomía con o sin istmectomía y lobectomía parcial en 2.3%, 40.3%, 44.2% y 13.2% respectivamente. Se practicó disección radical modificada del cuello, resección ganglionar parcial y ninguna disección ganglionar en 77.8%, 6.4% y 15.8%, respectivamente.

Los hombres y las mujeres fueron analizados por separado por cuanto sus factores de riesgo y pronóstico aparecieron significativamente diferentes. El análisis multivariable fue realizado de acuerdo con el modelo de regresión de riesgo de COX. Los factores independiente de significación relativa al pronóstico en los pacientes masculinos fueron la edad y las metástasis ganglionares macroscópicas; y la edad, las metástasis ganglionares macroscópicas, el tamaño del tumor y el número de tejidos/órganos adheridos en las del sexo femenino.

Con base en los factores de riesgo, los pacientes fueron clasificados en tres grupos: 65.6% de los pacientes masculinos quedaron clasificados en el grupo excelente y su tasa de sobrevida fue de 98.4%, 17.2% fueron clasificados como intermedios y 17.2% como pobres, con sobrevidas de 90.1% y 74% respectivamente. En los pacientes femeninos, 69.9% fueron clasificados en el grupo excelente, 18.6% en el intermedio y 11.9% en el pobre, con tasas de sobrevida a 10 años de 99.3%, 96.4% y 88.8% respectivamente.

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Authors and Affiliations

  1. Noguchi Thyroid Clinic and Hospital Foundation, 6-33 Noguchinaka-machi, 874, Beppu, Oita-ken, Japan

    Shiro Noguchi M.D., Ph.D., Nobuo Murakami M.D. & Hitoshi Kawamoto Ph.D.

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  1. Shiro Noguchi M.D., Ph.D.
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  2. Nobuo Murakami M.D.
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  3. Hitoshi Kawamoto Ph.D.
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Noguchi, S., Murakami, N. & Kawamoto, H. Classification of papillary cancer of the thyroid based on prognosis. World J. Surg. 18, 552–557 (1994). https://doi.org/10.1007/BF00353763

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