Risk Group Stratification in Thyroid Cancer

Disease Specific Survival – Age Stratification at 55 years
  • Age is a very strong predictor of outcome:
    • In differentiated thyroid cancer
  • Nearly 2/3 of the patients are younger that 55 years of age
    • They have a great long term survivorship:
      • Nearly 100% at 20 years
Disease Specific Survival – Gender
  • The majority of patients with thyroid cancer are women:
    • In this study from MSKCC
      • 73% of the cases were in women
  • Women have a slightly better 20 year survival (96%) compared to men (87%)
Disease Specific Survival – Tumor Histology
  • 94% of patients had papillary thyroid carcinoma with a very good longterm survival (93.7%) compared to follicular (87.9%) and Hurthle cell carcinomas (88%)
Disease Specific Survival – Tumor Size
  • In this study from MSKCC 92% of the patients had tumors less than 4 cm in size:
    • Tumors less that 4 cm in size had an excellent long term survival (95.2%) compared to tumors larger than 4 cm (74.5%)
Disease Specific Survival – Extrathyroid Extension
  • Gross extra-thyroid extension (ETE) only occurs in a minority of patients (9%):
    • This patients have a worse overall survival (74.9%) compared intra-thyroidal tumors (95.9%) and tumors with microscopic (96.6%) extra-thyroidal extension
Disease Specific Survival – Lymph Node Metastases N0 vs N+
  • Lymph node metastasis in general has a negative impact in long term survival:
    • However this difference is relatively small:
      • 96.2% in node negative patients vs. 89.2% in node positive patients
    • Studying the effect of lymph node metastasis in thyroid cancer survival:
      • Lymph node metastasis only had an adverse effect on survival in older patients (older than 55 years):
        • There is a progressive decline in disease specific survival as the years go bye
    • Young patients with and without nodal metastasis have excellent long term survival
Disease Specific Survival – Lymph Node Metastases and Age
Disease Specific Survival – Distant Metastasis
  • Distant metastasis will have an impact on long term survival:
    • Fortunately only 1.9% of differentiated thyroid cancers with present with distant metastasis
Differentiated Thyroid Cancer – GAMES
Patients in the GAMES low risk group have a 100% 20 year survival compared to the GAMES high risk group that only has a 77% 20 year survival. The intermediate GAMES group have a greater than 95% 20 year survival.
Risk of Recurrence
Ten-year DSS in 4881 DTC patients age less than 55 years at diagnosis by the 8th edition of the AJCC stage stratified by ATA risk category.
  • Only stage II patients with an ATA high risk category will have a a progressive increase in mortality as the years pass.
Lobectomy
  • The surgical outcome between total thyroidectomy and lobectomy is comparable when compared for:
    • Local recurrence free survival
    • Neck recurrence free survival
    • Distant recurrence free survival
    • Disease specific survival
    • Overall survival
10 year survival – Lobectomy vs Total Thyroidectomy
Extent of Surgery for Papillary Thyroid Cancer is Not Associated with a Survival Differance – An Analysis of 61,775 Patients (ACS, NCDB 1998-2006)
Extent of Surgery for Papillary Thyroid Cancer is Not Associated with a Survival Differance – An Analysis of 61,775 Patients (ACS, NCDB 1998-2006)
Isthmusectomy
  • What to do if the differentiated thyroid cancer is located to the isthmus and the lateral lobes are normal and no lymph node metastasis?
    • Is simple isthmusectomy the appropriate procedure?
Indications for a Total Thyrtoidectomy
  • When to perform more that a total thyroidectomy?
    • Gross extra thyroidal extension (anteriorly or posteriorly)
Surgery for Extrathyroid Extension
Long term Survival after Resection of Locally Advanced Thyroid Cancer
  • An R0 resection is fundamental when operating for gross extrathryoidal extension and performing more than a total thyroidectomy:
    • Patients in which an R0 resection can be performed will have long term survival exceeding 95% compared to patient with an R1 resection (60%)
    • R1 or R2 resections leads to a 40% decrease in survival

#Arrangoiz #ThyroidSurgeon #ThyroidExpert #CancerSurgeon #SurgicalOncologist #HeadandNeckSurgeon #DifferentiatedThyroidCancer #ThyroidCancer #PapillaryThyroidCancer #Mexico #Miami

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