Histological subtype is the most important determinant of survival in metastatic papillary thyroid cancer

<p>Abstract</p> <p>Background</p> <p>Papillary thyroid cancer (PTC) comprises the commonest type of thyroid cancer and carries the highest rate of survival. However, when metastatic disease occurs, survival is significantly affected.</p> <p>Methods</p> <p>We aimed to identify prognostic histopathological and clinical factors that modify survival in metastatic PTC. All cases of metastatic PTC treated at our department in the last 20 years were reviewed and analyzed.</p> <p>Results</p> <p>Histological subtype was the most important determinant of survival, as classic PTC demonstrated clearly improved survival compared to follicular subtype of PTC and other less frequently seen histological subtypes. The instant risk of death for the other histological subtypes was 4.56 times higher than the risk for the classic papillary type. Overall, a 10-year survival of 76.6% in our patients was seen.</p> <p>Conclusions</p> <p>Patients with aggressive variants of PTC are more at risk for the development of metastatic disease. In these patients, established treatment modalities (surgery, radioiodine therapy) should be offered promptly, as well as close follow-up.</p

Papillary Thyroid Carcinomas in Patients under 21 Years of Age: Clinical and Histologic Characteristics of Tumors &lt;= 10 mm

Objective To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) &lt;= 10 mm in patients &lt;= 21 years old with larger ones and with microcarcinomas in adults. Study design Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected. Results Patients &lt;= 21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC &lt;= 10mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors &lt;= 10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC &lt;= 10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups &lt;= 15, 15-18, and &gt; 18 to &lt;= 21 years old, respectively; P = .016). Mean tumor size was larger (6.8 +/- 2.7 vs 5.8 +/- 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients &lt;= 21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019). Conclusions The frequency of PTC &lt;= 10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable