Disease-free survival in papillary and follicular thyroid carcinoma

Summary

T stage was redefined for patients with differentiated thyroid carcinoma (DTC) between the 5^th and 7^th 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 7^th classification tended to be superior to the UICC 5^th 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

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