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Nuklearmedizin 2013; 52(03): 71-80
DOI: 10.3413/Nukmed-0530-12-09
Original article
Schattauer GmbH

Disease-free survival in papillary and follicular thyroid carcinoma

Comparison between UICC 5th and 7th classifications of T stage, and the prognostic value of primary tumour sizeKrankheitsfreies Überleben bei papillärem und follikulärem SchilddrüsenkarzinomVergleich der T-Stadien nach UICC-5- und UICC-7-Klassifikationen und der prognostische Wert des Primärtumordurchmessers
M. Meixner
1   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
M. Hellmich
2   Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Germany
,
M. Dietlein
1   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
C. Kobe
1   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
H. Schicha
1   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
M. Schmidt
1   Department of Nuclear Medicine, University Hospital of Cologne, Germany
› Institutsangaben
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Publikationsverlauf

received: 03. September 2012

accepted in revised form: 21. Januar 2013

Publikationsdatum:
30. Dezember 2017 (online)

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Summary

T stage was redefined for patients with differentiated thyroid carcinoma (DTC) between the 5th and 7th versions of the UICC tumour classification system. Patients, methods: 636 patients (486 women, 150 men; mean age 49.1 ± 15.6 years, mean follow-up 4.6 years) who had been treated with ablative radioiodine therapy after thyroidectomy for papillary (PTC) or follicular thyroid carcinomas (FTC) were retrospectively assessed on occurrence of locoregional recurrent disease, or cervical lymph node or distant metastases. Disease-free survival was calculated from initial T stage, classified according to both versions of the UICC staging system and compared with the prognostic value of primary tumour size. Kaplan-Meier method and two measures of explained variation, (1) R2 based on the (partial) likelihood ratio statistic of the Cox proportional hazards model and (2) a model-free variant of a distance measure proposed by Schemper had the aim to detect the most advantageous classification. Results: Of the 508 patients with PTC, 11 (2.2%) developed a local recurrence, 37 (7.3%) cervical lymph node and 23 (4.5%) distant metastases, 3 (2.3%), 8 (6.3%), and 18 (14.1%) were the numbers for the 128 FTC patients respectively. The two classification systems yielded an equal count of statistically significant differences regarding disease-free survival in patients with PTC while UICC 7th classification appeared slightly advantageous in patients with FTC. Regarding explained variation the UICC 7th classification tended to be superior to the UICC 5th classification, both in PTC and FTC, however statistical significance was not reached. Conclusion: The primary tumour size significantly added to the prognosis regarding local cervical and distant metastases.

Zusammenfassung

Zwischen der 5. und 7. Auflage der UICC-Klassifikation wurde das T-Stadium bei differenzierten Schilddrüsenkarzinomen (DTC) neu definiert. Patienten, Methoden: 636 Patienten (486 Frauen, 150 Männer; mittleres Alter 49,1 ± 15,6 Jahre, mittlere Nachsorge von 4,6 Jahren), die eine ablative Radioiodtherapie nach Thyreoidektomie eines papillären (PTC) oder follikulären (FTC) Schilddrüsenkarzinoms erhalten hatten, wurden retrospektiv im Hinblick auf das Auftreten von Lokalrezidiven, zervikalen Lymphknoten- oder Fernmetastasen ausgewertet. Das krankheitsfreie Überleben wurde vom initialen Tumorstadium nach beiden UICC-Klassifikationen berechnet und mit der prognostischen Bedeutung des Primärtumordurchmessers verglichen. Berechnungen nach der Kaplan-Meier-Methode und von zwei Variationsmaßen (1) R2 basierend auf einem (partiellen) Wahrscheinlichkeitsverhältnis nach dem Cox-Proportional-Hazards-Modell und (2) einer Modell-freien Variante des Distanzmaßes nach Schemper sollten die vorteilhafteste Klassifikation identifizieren. Ergebnisse: Von 508 PTC-Patienten entwickelten 11 (2,2%) ein Lokalrezidiv, 37 (7,3%) zervikale Lymphknoten- und 23 (4,5%) Fernmetastasen, analog gab es 3 (2,3%), 8 (6,3%) und 18 (14,1%) FTC-Patienten mit Rezidiven. Beide UICC-Klassifikationssysteme erreichten eine gleiche Zahl statistischer Unterschiede im krankheitsfreien Überleben bei PTC-Patienten, wohin gegen die UICC-7-Klassifikation einen leichten Vorteil bei FTC-Patienten hatte. In den Variations maßen gab es nur einen Trend zugunsten der UICC-7-Klassifikation sowohl bei PTC- als auch bei FTC-Patienten, allerdings ohne statistische Signifikanz. Schlussfolgerung: Der Primär tumor durchmesser hatte wesentliche prognostische Bedeutung für das Auftreten von zervikalen Lymphknoten- und Fernmetastasen.

Keywords

Papillary thyroid carcinoma - follicular thyroid carcinoma - T stage - tumour diameter - lymph node metastases - distant metastases - disease-free survival

Schlüsselwörter

Papilläres Schilddrüsenkarzinom - follikuläres Schilddrüsenkarzinom - T-Stadium - Tumordurch messer - Lmphknotenmetastase - Fernmetastase - krankheitsfreies Überleben
 

  • References

  • 1 Bertz J, Kraywinkel K. 2010 Verbreitung von Krebserkrankungen in Deutschland. Entwicklung der Prävalenzen zwischen 1990 und 2010. Beiträge zur Gesundheitsberichterstattung des Bundes.. Berlin: Robert Koch-Institut; 2010: 124-131.
    Google Scholar
  • 2 Bhattacharyya N. A population-based analysis of survival factors in differentiated and medullary thyroid carcinoma. Otolaryngol Head Neck Surg 2003; 128: 115-123.
    CrossrefPubMedGoogle Scholar
  • 3 Cooper DS, Doherty GM. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214.
    CrossrefPubMedGoogle Scholar
  • 4 Dietlein M. Dressler et al. Procedure guidelines for radioiodine therapy of differentiated thyroid cancer. Nuklearmedizin 2007; 46: 213-219.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Döbert N, Menzel C. et al. Differentiated thyroid carcinoma: the new UICC 6th edition TNM classification system in a retrospective analysis of 169 patients. Thyroid 2004; 14: 65-70.
    CrossrefPubMedGoogle Scholar
  • 6 Eichhorn W, Tabler H. et al. Prognostic factors determining long-term survival in well-differentiated thyroid cancer: an analysis of four hundred eighty-four patients undergoing therapy and aftercare at the same institution. Thyroid 2003; 13: 949-958.
    CrossrefPubMedGoogle Scholar
  • 7 Eustatia-Rutten CFA, Corssmit EPM. et al. Survival and Death Causes in Differentiated Thyrid Carcinoma. J Clin Endocrinol Metab 2006; 91: 313-319.
    CrossrefPubMedGoogle Scholar
  • 8 Gilliland FD, Hunt WC. et al. Prognostic factors for thyroid carcinoma. A population-based study of 15 698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973–1991. Cancer 1997; 79: 564-573.
    CrossrefPubMedGoogle Scholar
  • 9 Hay ID, Bergstralh EJ. et al. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993; 114: 1050-1058.
    PubMedGoogle Scholar
  • 10 Hay ID, Thompson GB. et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 2002; 26: 879-885.
    CrossrefPubMedGoogle Scholar
  • 11 Hundahl SA, Cady B. et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. US and German Thyroid Cancer Study Group. Cancer 2000; 89: 202-217.
    CrossrefPubMedGoogle Scholar
  • 12 Hundahl SA, Fleming ID. et al. A National Cancer Data Base Report on 53,856 Cases of Thyroid Carcinoma Treated in the US, 1985–1995. Cancer 1998; 83: 2638-2648.
    CrossrefPubMedGoogle Scholar
  • 13 Ito Y, Tomoda C. et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 2006; 30: 780-786.
    CrossrefPubMedGoogle Scholar
  • 14 Kent JT, O’Quigley J. Measures of dependence for censored survival data. Biometrika 1988; 75: 525-534.
    CrossrefGoogle Scholar
  • 15 Krämer JA, Schmid KW. et al. Primary tumour size is a prognostic parameter in patients suffering from differentiated thyroid carcinoma with extrathyroidal growth: results of the MDS trial. Eur J Endocrinol 2010; 163: 637-644.
    CrossrefPubMedGoogle Scholar
  • 16 Lang BH, Lo CY. et al. , Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg 2007; 245: 366-378.
    CrossrefPubMedGoogle Scholar
  • 17 Lang BH, Lo CY. et al. Prognostic factors in papillary and follicular thyroid carcinoma: their implications for cancer staging. Ann Surg Oncol 2007; 14: 730-738.
    CrossrefPubMedGoogle Scholar
  • 18 Lang B, Lo CY. et al. Restaging of differentiated thyroid carcinoma by the sixth edition AJCC/ UICC TNM staging system: stage migration and predictability. Ann Surg Oncol 2007; 14: 1551-1559.
    CrossrefPubMedGoogle Scholar
  • 19 Lerch H, Schober O. et al. Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol 1997; 15: 2067-2075.
    CrossrefPubMedGoogle Scholar
  • 20 Luster M, Clarke SE. et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2008; 35: 1941-1959.
    CrossrefPubMedGoogle Scholar
  • 21 Machens A, Holzhausen HJ. et al. , The prognostic value of primary tumour size in papillary and follicular thyroid carcinoma. Cancer 2005; 103: 2269-2273.
    CrossrefPubMedGoogle Scholar
  • 22 Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97: 418-428.
    CrossrefPubMedGoogle Scholar
  • 23 Mizukami Y, Michigishi T. et al. Distant metastases in differentiated thyroid carcinomas: A clinical and pathologic study. Hum Pathol 1990; 21: 283-290.
    CrossrefPubMedGoogle Scholar
  • 24 Pacini F, Schlumberger M. et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803.
    CrossrefPubMedGoogle Scholar
  • 25 Pacini F, Castagna MG. et al. Differentiated thyroid cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 (Suppl. 04) 143-146.
    PubMedGoogle Scholar
  • 26 Passler C, Prager G. et al. B Application of staging systems for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution. Ann Surg 2003; 237: 227-234.
    PubMedGoogle Scholar
  • 27 Passler C, Scheuba C. et al. Importance of tumour size in papillary and follicular thyroid cancer. Br J Surg 2005; 92: 184-189.
    CrossrefPubMedGoogle Scholar
  • 28 Pellegriti G, Scollo C. et al. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab 2004; 89: 3713-3720.
    CrossrefPubMedGoogle Scholar
  • 29 Rahbar K, Hutzenlaub V. et al. Risk-profile and outcome of small papillary and follicular thyroid carcinomas (< 1 cm). Nuklearmedizin 2008; 47: 188-193.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 30 Podnos YD, Smith D. et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg 2005; 71: 731-734.
    Google Scholar
  • 31 Riemann B, Krämer JA. et al. Risk stratification of patients with locally aggressive differentiated thyroid cancer. Results of the MSDS trial. Nuklearmedizin 2010; 49: 79-84.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 32 Rosenbaum-Krumme SJ, Wieduwilt M. et al. Estimation of tumour mass in patients with differentiated thyroid carcinoma using serum thyroglobulin. Nuklearmedizin 2012; 51: 217-222.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 33 Samaan NA, Schultz PN. et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 1992; 75: 714-720.
    PubMedGoogle Scholar
  • 34 Sacks W, Fung CH. et al. The effectiveness of radioactive iodine for treatment of low-risk thyroid cancer: a systematic analysis of the peer-reviewed literature from 1966 to April 2008. Thyroid 2010; 20: 1235-1245.
    CrossrefPubMedGoogle Scholar
  • 35 Schemper M. The explained variation in proportional hazards regression. Biometrika 1990; 77: 216-218.
    CrossrefGoogle Scholar
  • 36 Sherman SI, Brierley JD. et al. Prospective multicenter study of thyroid carcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer 1998; 83: 1012-1021.
    CrossrefPubMedGoogle Scholar
  • 37 Sobin LH, Wittekind C. 1997. UICC: TNM classification of malignant tumours.. 5th ed. New York: Wiley-Liss;
  • 38 Sobin LH, Wittekind C. 2002. UICC: TNM classification of malignant tumours.. 6th ed. New York: Wiley-Liss;
  • 39 Sobin LH, Gospodarowicz M. et al. 2009. TNM Classification of malignant tumours.. 7th ed. New York: Wiley-Liss;
  • 40 Steinmüller T, Klupp J. et al. Prognostic factors in patients with differentiated thyroid carcinoma. Eur J Surg 2000; 166: 29-33.
    CrossrefPubMedGoogle Scholar
  • 41 Sugino K, Ito K. et al. Prognosis and prognostic factors for distant metastases and tumor mortality in follicular thyroid carcinoma. Thyroid 2011; 21: 751-757.
    CrossrefPubMedGoogle Scholar
  • 42 Tuttle RM, Tala H. et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 2010; 20: 1341-1349.
    CrossrefPubMedGoogle Scholar
  • 43 Verburg FA, Mäder U. et al. A comparison of prognostic classification systems for differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2010; 72: 830-838.
    Google Scholar
  • 44 Verburg FA, Mäder U. et al. Primary tumour diameter as a risk factor for advanced disease features of differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2009; 71: 291-297.
    CrossrefPubMedGoogle Scholar
  • 45 Verburg FA, Stokkel MP. et al. No survival difference after successful I-131 ablation between patients with initially low-risk and high-risk differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2010; 37: 276-283.
    CrossrefPubMedGoogle Scholar
  • 46 Voutilainen PE, Siironen P. et al. AMES, MACIS and TNM prognostic classifications in papillary thyroid carcinoma. Anticancer Res 2003; 23: 4283-4288.
    Google Scholar
  • 47 Vrachimis A, Schober O, Riemann B. Radioiodine remnant ablation in differentiated thyroid cancer after combined endogenous and exogenous TSH stimulation. Nuklearmedizin 2012; 51: 67-72.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 48 Wada N, Nakayama H. et al. Prognostic value of the sixth edition AJCC/UICC TNM classification for differentiated thyroid carcinoma with extrathyroid extension. J Clin Endocrinol Metab 2007; 92: 215-218.
    CrossrefPubMedGoogle Scholar
  • 49 Wong R, Bresee C, Braunstein G. Comparison with published systems of a new staging system for papillary and follicular thyroid carcinomas. Thyroid. 2012 DOI: 10.1089/thy.2012.0181
    CrossrefPubMedGoogle Scholar