Enhancement of lymph node metastasis and distant metastasis of thyroid carcinoma.
Andreas Machens,Hans-Jürgen Holzhausen,Christine Lautenschläger,Phuong Nguyen Thanh,Henning Dralle +4 more
TL;DR: The mechanisms of local and distant metastases of thyroid malignancies are imperfectly understood and the goal of the current study was to add to the body of knowledge.
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Abstract: BACKGROUND
The mechanisms of local and distant metastases are imperfectly understood. The goal of the current study was to add to the body of knowledge regarding local and distant metastases of thyroid malignancies.
METHODS
The authors performed multivariate analysis of 573 patients who underwent surgery between November 1994 and May 2002 for follicular (FTC; n = 100), papillary (PTC; n = 236), or medullary thyroid carcinoma (MTC; n = 237) at a university hospital.
RESULTS
In multivariate analysis, extrathyroidal extension consistently evolved as the key risk factor for both lymph node metastasis and distant metastasis. This correlation was most pronounced in MTC and least pronounced in FTC. The risk of lymph node metastasis also increased with reoperative status in patients with MTC and with primary tumor diameter in patients with MTC (tumor diameter > 10 mm) and patients with PTC (tumor diameter > 20 mm). In the PTC group, lymph node metastasis was more common among patients younger than age 45. In the MTC group, extrathyroidal growth and distant metastasis were associated exclusively with lymph node metastasis. Lymph node metastasis was the only secondary risk factor for distant metastasis. In the analysis of risk factors for distant metastasis in the FTC and PTC groups, no interaction was found between extrathyroidal growth and lymph node metastasis. This finding suggests that extrathyroidal growth and lymph node metastasis of FTC and PTC, and presumably also MTC, represent separate mechanisms and routes of distant metastasis.
CONCLUSIONS
Screening for both local residual disease and distant metastases should be intensified in the high-risk population of patients whose primary tumors exhibit large diameters, extrathyroidal growth, or lymph node metastasis. Cancer 2003;98:712–9. © 2003 American Cancer Society.
DOI 10.1002/cncr.11581
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Citations
Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment.
S. Bonnet,Dana M. Hartl,Sophie Leboulleux,Eric Baudin,Jean Lumbroso,Abir Al Ghuzlan,Linda Chami,Martin Schlumberger,Jean Paul Travagli +8 more
TL;DR: Precise LN staging by prophylactic neck dissection for tumors initially staged T1N0 modified the indication for radioiodine ablation for 30% of patients.
Prospects of Remission in Medullary Thyroid Carcinoma According to Basal Calcitonin Level
TL;DR: Preoperative basal calcitonin levels may help individualize the extent of surgery and postoperative follow-up intervals for MTC, and there were no differences between patients with sporadic and hereditary MTC after adjusting for multiple testing.
German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors
Henning Dralle,Thomas J. Musholt,Jochen Schabram,Thomas Steinmüller,A. Frilling,D. Simon,Peter E. Goretzki,Bruno Niederle,Christian Scheuba,Thomas Clerici,M. Hermann,Jochen Kußmann,Kerstin Lorenz,Christoph Nies,P. Schabram,A Trupka,Andreas Zielke,Wolfram Karges,Markus Luster,Kurt Werner Schmid,Dirk Vordermark,Hans-Joachim Schmoll,Reinhard Mühlenberg,Otmar Schober,Harald Rimmele,Andreas Machens,Visceral Surgery,Radiooncology,Oncological Hematology +28 more
TL;DR: These evidence-based recommendations for surgical therapy reflect various “treatment corridors” that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
286
The Treatment of Differentiated Thyroid Cancer in Children: Emphasis on Surgical Approach and Radioactive Iodine Therapy
Scott A. Rivkees,Ernest L. Mazzaferri,Ernest L. Mazzaferri,Frederik A. Verburg,Christoph Reiners,Markus Luster,Christopher K. Breuer,Catherine A. Dinauer,Robert Udelsman +8 more
TL;DR: It is recommended that total thyroidectomy and central compartment lymph node dissection is the surgical procedure of choice for children with DTC if it can be performed by a high-volume thyroid surgeon and long-term follow-up is recommended.
Prevalence and prognostic significance of tall cell variant of papillary thyroid carcinoma
TL;DR: Treatment was similar in both groups, but neck dissection was performed more frequently in patients with TCV, and it is a more aggressive form of PTC than CF because of the higher stage and increased grade.
130
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