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T P Links
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K M van Tol
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P L Jager
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J Th M Plukker
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D A Piers
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H M Boezen
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R P F Dullaart
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E G E de Vries
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W J Sluiter
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In differentiated thyroid carcinoma 10-year survival rates amount to 80–95%. Because age at diagnosis varies widely, these survival rates strongly depend on age at presentation. The aim of the present study was to analyse the attributable risk factors, including therapy per se, on survival in thyroid cancer after proper adjustment for the baseline mortality rate in the general population and to elucidate the adverse treatment effects on survival. Initial treatment in 504 patients consisted of thyroidectomy and 131I ablation. High-dose 131I was administered for residual disease. Patients in complete remission underwent an annual physical examination and thyroglobulin measurements during TSH suppression. Survival time was studied after transformation to standardised survival time to adjust for the baseline mortality rate in the general population.

Median follow-up since diagnosis was 9 years. The 10-year overall survival was 83% and disease-specific survival 91%. After initial treatment, persistent disease occurred in 75 patients (15%). In univariate analysis, T4, N1, M1 status and Hürthle cell type were prognostic for persistent and recurrent disease. Age was not prognostic for recurrent disease in multivariate analysis. The standardised survival time was not altered in disease-free patients. However, patients with persistent disease had a median standardised survival time of only 0.60 (95% confidence interval 0.47;0.72), ranging from 0 to above 1, independent of initial tumour status or age. The cumulative proportion of persistent disease was at least 20% of the whole group.

Disease-free patients after thyroid carcinoma have a normal residual life span. In contrast, in cases of persistent disease the life expectancy ranges widely with its median being reduced to 60%. Overall, treatment including radioiodine is safe but unsuccesful in 20% of the patients. Age is not a disease-specific risk factor and should not be used as an independent factor in treatment algorithms.

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Frederic Castinetti Department of Endocrinology Aix Marseille University, CNRS UMR7286 La Conception Hospital, Hopitaux de Marseille, Marseille, France

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Ana Luiza Maia Thyroid Section, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

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Mariola Peczkowska Department of Hypertension, Institute of Cardiology, Warsaw, Poland

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Marta Barontini Center for Endocrinological Investigations, Hospital de Ninos R Gutierrez, Buenos Aires, Argentina

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Kornelia Hasse-Lazar Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska Curie Memorial Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland

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Thera P Links Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands

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Rodrigo A Toledo Department of Endocrinology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

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Sarka Dvorakova Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic

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Caterina Mian Operative Unit of the Endocrinology Department of Medicine (DIMED), University of Padova, Padova, Italy

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Maria Joao Bugalho Hospital de Santa Maria – CHLN, Lisboa, Portugal

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Stefania Zovato Department of Medicine (DIMED), University of Padova, Padova, Italy

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Maria Alevizaki Endocrine Unit Evgenideion Hospital and Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Athens, Greece

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Andrei Kvachenyuk Institute of Endocrinology, Kiev, Ukraine

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Birke Bausch 2nd Department of Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany

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Paola Loli Department of Endocrinology, Ospedale Niguarda Cà Granda, Milan, Italy

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Simona R Bergmann Division of Endocrinology and Diabetology, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany

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Attila Patocs Molecular Medicine Research Group, HSA-SE ‘Lendület’ Hereditary Endocrine Tumor Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary

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Marija Pfeifer Department of Endocrinology, University Medical Center Ljubljana, Ljubljana, Slovenia

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Josefina Biarnes Costa Hospital Universitari de Girona, Gerencia Territorial Girona, Institut Català de la Salut, Girona, Spain

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Ernst von Dobschuetz Department of Visceral Surgery, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany

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Claudio Letizia Department of Internal Medicine and Medical Specialties, University La Sapienza, Rome, Italy

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Gerlof Valk Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, Netherlands

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Marcin Barczynski Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University, Medical College, Krakow, Poland

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Malgorzata Czetwertynska Department of Endocrinology, Maria Sklodowska Curie Memorial Center and Institute of Oncology, Warsaw, Poland

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John T M Plukker Department of Surgery, University Medical Centre, Groningen, Netherlands

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Paola Sartorato Department of Internal Medicine, General Hospital, Montebelluna, Treviso, Italy

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Tomas Zelinka 3rd Department of Medicine, Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic

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Petr Vlcek Department of Nuclear Medicine and Endocrinology, Second Faculty of Medicine, Charles University, Prague, Czech Republic

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Svetlana Yaremchuk Institute of Otolaryngology NAMS of Ukraine, Kiev, Ukraine

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Georges Weryha Department of Endocrinology, University Hospital, Nancy, France

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Letizia Canu Department of Experimental and Clinical Biomedical Sciences, Endocrinology Unit, University of Florence, Florence, Italy

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Nelson Wohllk Endocrine Section, Universidad de Chile, Hospital del Salvador, Santiago de Chile, Chile

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Frederic Sebag Department of Endocrine Surgery, Aix-Marseille University, La Conception Hospital, Marseille, France

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Martin K Walz Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany

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Charis Eng Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA

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Hartmut P H Neumann Section for Preventive Medicine, Department of Nephrology and General Medicine, University Medical Centre, Albert Ludwigs University of Freiburg, Freiburg, Germany

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