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Research Article | DOI: https://doi.org/10.31579/2690-1919/062
* Department of General Surgery, Zagazig University, Zagazig, Egypt.
*Corresponding Author: Hassan A. Awad, Department of General Surgery, Zagazig University, Zagazig, Egypt
Citation: Hassan A. Awad, Prognostic Factors and Survival of the Differentiated Thyroid Cancer Retrospective Study. J Clinical Research and Reports, 3(5); DOI:10.31579/2690-1919/062
Copyright: © 2020 Hassan A. Awad. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 March 2020 | Accepted: 12 March 2020 | Published: 16 March 2020
Keywords: DTCs; PTC; FTC; thyroid cancer; postoperative 131I-treatment; TNM
The Differentiated Thyroid Cancers (DTCs) is referred to the Papillary (PTC) and follicular (FTC) thyroid cancers. The thyroid cancer incidence was increased in recent years 1. Thyroid cancer is approximately represented 1% of all diagnosed cancer cases yearly 2. The Prognosis of thyroid malignancies is ranged from the most frequently seen differentiated carcinoma (papillary thyroid carcinoma – PTC, and follicular thyroid carcinoma – FTC), to the less common aggressive, but the most aggressively growing is an anaplastic type.
The thyroid cancer is count for approximately 1% of all diagnosed cancer patients yearly 1. Thyroid cancer range from the most frequently differentiated carcinoma; papillary thyroid carcinoma (PTC), and follicular thyroid carcinoma (FTC) to less common and most aggressively nature undifferentiated anaplastic types.
The differentiated thyroid carcinoma has a good favorable course that relative to another differentiated thyroid tumor. The tumor specific mortality is the low mortality rate, and the life expectancy continues to be improved during the recent 10 years, due to the advanced diagnostic and therapeutic protocols tools 2. However, some cases have poor prognosis in this group, because of late diagnosis and ignorance and lower educated types of patients 3.
The major differences in the treatment of the thyroid malignancy are about the different planes of the surgery intervention; extend of excision indicating different protocols of postoperative 131I-treatment. The surgery is the primary treatment, and lymph nodes metastases degree that affecting the patients survival rate.
Among these most important complications, the recurrent laryngeal nerve paralysis, and hypoparathyroidism. The incidence of these complications is less common in the first operation. It is important to determine the extent of the surgical intervention before or during operation sitting 4. The most radical procedure, total thyroidectomy for all patients, after pre- and intraoperative diagnostic methods when the result of the histology reveals carcinoma, the option will total thyroidectomy after frozen results.
The post-operative treatment, the follow-up care, and the changes in the patient’s life quality that underwent surgery for the differentiated thyroid carcinoma type is an important public health subject. So, these patients will require long life follow-up care.
It is necessary to adhere to an individualized long-term follow-up system in our age of cost-oriented health care plane, as the number of lost workdays is significant /certain diagnostic procedures are unusual or unsuitable to use routinely, because of either their high cost such as CT, MRI, PET, or as they can also affect the patients adversely with it 3.
The side effect of performing whole-body 131I scan, or 131I therapy, after one-month suspension of thyroid substitution, can adversely make hypothyroidism that affecting the patients’ quality life, or vocal cord affections complications. The matching and dividing patients into groups based on the available specific data, and prognostic factors preoperative can be helpful to clarify those cases that requiring more detailed and therapy.
Due to the long survival period, a good plane of surgery requires the long-term follow-up. Therefore, they were claimed by retrospective studies; data from prospective studies that not yet published. The survival depends on tumor size, lymph node and distant metastases , determined by TNM classification, also other factors. The study included papillary, follicular, or both types. The long-term good prognosis of differentiated thyroid carcinomas is still unknown reasons. The response of the immune system is a possible explanation of the lymphocytic infiltration that is not understood completely. The effects of iodine deficiency with above-mentioned factors have not been reported. The effects of ionizing radiation on the pathogenesis of the thyroid carcinoma, is not understood good and were examined by many investigations.
Our aim explains to the following questions:
A- What prognostic factors influence the long-term survival in patients with differentiated thyroid carcinoma?
1 – A factor of gender and the age
2- The tumor mass size, distal metastasis and lymph nodes number and metastasis
3 - Histological characteristics of the tumor?
4- Lymphocytic infiltration and iodine supply, iodine deficiency complications affecting the morphological characteristics of thyroid tumor
5- TNM classification changes after surgical treatment and radioactive iodine during the study period?
At the zagazig university surgical department, 250 patients were operated on for the differentiated types of thyroid carcinoma between 2010 and 2018; 176 for papillary carcinoma and 93 for follicular carcinoma. The data of all 250 patients have been analyzed during the period of the retrospective study.
Survival data and complications have been obtained from the operating and post- operative documentation. The multifocality, multicentricity, lymphocytic infiltration, and iodine deficiency or supply, all have been examined in our retrospective study in both the papillary and follicular groups.
The tumor size, lymph node number extend and the distant metastases, total thyroidectomy (the complete removal of the gland) or near total (when only small suspected normal tissue about 0.5-1 cm3 of either thyroid lobe is spared), close to the rear capsule to be followed by 131I ablation, to avoid recurrent laryngeal nerve injury and parathyroid removal or deprivation of blood supply.
The histology specimens were re-evaluated again and the diagnosis was revised based on the classification guideline were analyzed. The extent of lymphocytic infiltration in the tumor was important and also evaluated that associated with good prognosis. Others studies clarified that the iodine intake correlated good with the iodine level in Hungary period. The survival curve calculations were done by the SPSS in our Windows program and the data were then analyzed by Cox regression. TNM analyzed changes and the operation types in two separate periods of our retrospective period, also we compared incidence and age distribution of the histologically and degree of differentiation of the different carcinomas types.
The survival of differentiated thyroid carcinoma was affected by several factors other than those determined by the commonly accepted TNM classification as tumor mass size or lymph node metastases site, number, and distant metastases 8. Various scoring factors and systems have been created based on the results of the retrospective studies done before. In Table 3, we compare our data to those factors that considered major affection factors by most other authors.
The two types of the differentiated carcinomas papillary and follicular have to be examined separated due to their different biological behavior. The age at the time of discovery or patients examination is the most important prognostic factor in both types groups, with their recurrence and mortality rates that increasing after age 40, recurrence appears early stage, and death sooner after recurrence, indicating faster tumor growth and mitotic rate and tumor behavior. Furthermore, these tumors had less differentiated, and 131I isotope uptake is low uptake and effects by both the primary tumors and their metastases. Our results indicate a little or continuous increase in the patient numbers, with an increased proportion of papillary type of carcinomas that more frequent presence of early stage tumors during the time period of our study. As Improved diagnostic techniques, and widespread use of ultrasound imaging and fine needle-guided and its increasing use as a screening techniques.
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