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Intermediate-risk group for differentiated carcinoma of thyroid
A R Shaha1, T R Loree, J P Shah
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Surgery
|December 1, 1994
Summary
Differentiated thyroid cancer patients are categorized into low, intermediate, and high-risk groups. The intermediate-risk group, comprising 39% of patients, requires careful consideration for aggressive treatment due to a 15% mortality rate over 20 years.
Area of Science:
- Oncology
- Endocrinology
- Cancer Research
Background:
- Established prognostic factors for differentiated thyroid carcinoma include age, tumor size, extrathyroid extension, histologic grade, gender, and distant metastasis.
- These factors stratify patients into low-risk (excellent prognosis) and high-risk (significant mortality) groups.
- A distinct intermediate-risk category exists, necessitating careful treatment decisions.
Purpose of the Study:
- To identify and characterize prognostic factors in differentiated thyroid carcinoma.
- To refine risk stratification for patients with differentiated thyroid cancer.
- To guide treatment decisions for intermediate-risk patients.
Main Methods:
- Retrospective review of 1038 previously untreated patients with differentiated thyroid carcinoma over 55 years.
- Univariate and multivariate analyses were performed on gathered chart data.
- Patients were classified into low-, intermediate-, and high-risk categories based on age, metastasis, tumor size, grade, and histology.
Main Results:
- Median follow-up was 20 years.
- Low-risk group: 99% 20-year survival.
- High-risk group: 57% 20-year survival.
- Intermediate-risk group (403 patients): 85% 20-year survival.
- Identified a distinct intermediate-risk category encompassing low-risk patients with high-risk tumors and vice-versa.
Conclusions:
- The study confirms a distinct intermediate-risk category in differentiated thyroid carcinoma.
- Patients in this intermediate-risk group exhibit a 20-year survival rate of 85%.
- An aggressive treatment approach, tailored to individual prognostic factors, is recommended for intermediate-risk patients.