Death from thyroid cancer of follicular cell origin

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).