SURVIVAL OF DIFFERENTIATED THYROID-CARCINOMA STUDIED IN 500 PATIENTS

Purpose: To analyze the factors that influence survival of patients wi th differentiated thyroid carcinoma treated by surgical thyroidectomy, radioactive iodine, and early surgical reintervention with compartmen t-oriented lymphadenectomy in the case of locoregionol recurrence. Met hods: The survival of 500 patients with differentiated thyroid carcino ma was analyzed retrospectively with regard to mortality and survival rare (Kaplan-Meier). A total,of 301 patients had papillary and 199 fol licular thyroid carcinoma. The mean age of the 380 women and 120 men w as 46.8+/-16.4 years at presentation. All patients were treated by sur gical thyroidectomy, high-dose radioactive iodine, and early surgical reintervention with compartment-oriented lymphadenectomy in cases of l ocoregional recurrence, without routine adjuvant external radiotherapy of the neck. patients were monitored up to 23 years, with a median fo llowup time of 5.6 years. Results: Twenty-nine of 500 patients died, 1 9 of thyroid cancer. The corrected overall 5-year survival rate (Kapla n-Meier) was 0.92. Among patients with tumor stage pTl-3NO-1MO (low ri sk), none died of thyroid carcinoma (5-year survival rate, 0.97); in p atients with tumor stage pT4 and/or M1 (high risk), the 5-year surviva l rate was 0.83. The cause of death was locoregional recurrence in eig ht and metastatic disease in 11. Using multivariate analysis, risk fac tors that significantly influence survival were local invasion (pT4), metastatic disease (M1), and age. Conclusion: In differentiated thyroi d carcinoma, the use of total surgical thyroidectomy followed by high- dose radioiodine therapy and early surgical reintervention in case of locoregional recurrence yields high survival rates, even without adjuv ant external radiotherapy of the neck. (C) 1997 by American Society of Clinical Oncology.