Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996 - An American College of Surgeons Commission on Cancer Patient Care Evaluation study

BACKGROUND. The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHO DS. Over 1500 hospitals with CoC-approved cancer programs were invited to p articipate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer D ata Base. RESULTS. Of the 5584 cases of thyroid carcinoma, 81% were papilla ry, 10% follicular, 3.6% Hurthle cell, 0.5% familial medullary, 2.7% sporad ic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspec ted risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasoun d (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relative ly small tumors. For all histologies, near-total or total thyroidectomy con stituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event c ould be documented in 11% of cases, hypocalcemia in 10% of cases, and recur rent laryngeal nerve injury in 1.3% of cases. Complications were most frequ ently associated with total thyroidectomy combined with lymph node dissecti on. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably u nderreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS. In addition to offering inform ation concerning risk factors and symptoms, the current PCE study complimen ts the survival information from previous NCDB reports and offers a surveil lance snapshot of current management of thyroid carcinoma in the U.S. Ident ified opportunities for improvement of care include 1) more frequent use of fine-needle-aspiration cytology in making a diagnosis; 2) more frequent us e of laryngoscopy in evaluating patients preoperatively, especially those w ith voice change; and 3) improved lymph node resection and analysis to impr ove staging and, in some situations, outcomes. [See commentary on pages 1-4 , this issue and communication on pages 192-201, this issue.] (C) 2000 Amer ican Cancer Society.