Background: Although patients with differentiated thyroid cancer (DTC) of f
ollicular cell origin usually have an excellent prognosis, some patients di
e from progressive tumor. Numerous postoperative criteria have been used to
predict prognosis in patients with DTC. The purpose of this investigation
was to determine whether the TNM and metastases, age, completeness of resec
tion, invasion, size (MACIS) classifications predicted survival time and wh
y patients died from DTC. The extent of initial treatment and causes of dea
th were also evaluated in these patients who died from thyroid cancer.
Study Design: Between 1965 and 1995, 102 of 1,224 patients with DTC treated
at the University of California at San Francisco (UCSF) and UCSF/Mount Zio
n Medical Centers died from DTC. Risk factors including age at diagnosis, g
ender, histologic characteristics, TNM and MACIS classifications, the inter
vals among initial treatment, recurrence, and death, and the initial and su
bsequent treatments were documented in these 102 patients.
Results: Among the 102 patients who died of DTC 50% were men and 50% were w
omen. The mean age of patients with DTC at diagnosis was 58 years at recurr
ence, 62 and 65 years at death. Thirty percent of these patients initially
had unilateral thyroid operations and 70% had a bilateral operation. Tumors
at presentation ranged from 0.6 to 13.0 cm (mean 4.4 cm); 46% of patients
presented with late-stage tumors (TNM stage III, IV MACIS score > 8). At pr
esentation 46% of the patients had locally recurrent disease or regional me
tastases and 18% had distant metastases. Patients with persistent disease h
ad a significantly shorter survival time than those with recurrent disease
(p < 0.001). Both TNM and MACIS classifications were good predictors of sur
vival time. Reoperations were performed in 51% of papillary, 26% of follicu
lar, and 67% of Hurthle cell thyroid cancer patients. Fifty percent of pati
ents with papillary thyroid cancer, 50% of patients with Hurthle cell thyro
id cancer, and 11% of patients with follicular cell thyroid cancer died of
locally advanced disease.
Conclusions: As expected, patients with local or regional recurrence and th
ose with TNM stage I or MACIS score < 6 survived longer than patients with
distant metastasis and TNM stage III or IV; MACIS score > 6, but some patie
nts thought to be at low risk (TNM stage I; MACIS < 6) also died from thyro
id cancer. (J Am Coil Surg 2000;191:600-606. (C) 2000 by the American Colle
ge of Surgeons).