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Locally advanced differentiated thyroid carcinoma: a 35-year mono-institutional experience in 280 patients

Rosa Pelizzo, Mariaa; Toniato, Antonioa; Boschin, Isabella Merantea; Piotto, Andreaa; Bernante, Paoloa; Pagetta, Costantinoa; Palazzi, Margheritaa; Maria Guolo, Annab; Preo, Paolob; Nibale, Otelloc; Rubello, Domenicod

Nuclear Medicine Communications: November 2005 - Volume 26 - Issue 11 - pp 965-968
Original Articles

Aim: Debate exists in the literature about the optimal treatment to be adopted in patients with locally advanced differentiated thyroid carcinoma. We aimed to better define the most appropriate diagnostic and therapeutic protocol for this type of tumour.

Methods: The clinical and histopathological records of 280 consecutive patients with locally advanced differentiated thyroid carcinoma, studied and operated on by the same surgical team in the period between 1967 and 2002, were reviewed.

Results: With regard to overall survival, at univariate statistical analysis, the patient's age at diagnosis (threshold, 45 years), primary tumour size, local cancer extension at diagnosis (subtypes of T4), extent of thyroidectomy, performance of lymph node dissection and performance of post-surgical external radiotherapy were found to be significant prognostic variables. With regard to the appearance of recurrent disease during follow-up, at univariate statistical analysis, the patient's age at initial diagnosis (threshold, 45 years), primary tumour size, local cancer extension at diagnosis (subtypes of T4), extent of thyroidectomy, performance of lymph node dissection, presence of metastatic lymph nodes, performance of post-surgical 131I therapy and performance of post-surgical external radiotherapy were found to be significant prognostic variables. At multivariate statistical analysis, the patient's age at initial diagnosis, extent of tumour, extent of thyroidectomy and performance of lymph node dissection were the only independent prognostic variables.

Conclusions: In our experience, an aggressive surgical approach at first diagnosis appears to offer a better prognosis in terms of both overall survival and disease-free time interval in patients with locally advanced differentiated thyroid carcinoma, especially those over 45 years of age.

Departments of aSurgery

bStatistical Sciences, University of Padova Medical School, Padova

cMedical Physics Service

dNuclear Medicine Service, S. Maria della Misericordia Hospital, Rovigo, Italy

Correspondence to Dr Domenico Rubello, Nuclear Medicine Service – PET Unit, S. Maria della Misericordia Hospital, Istituto Oncologico Veneto (IOV), I-45100, Rovigo, Italy

Tel: ++39 (0)425 394427; fax: ++39 (0)425 394434;

e-mail: rubello.domenico@azisanrovigo.it

Received 27 July 2005 Accepted 15 August 2005

© 2005 Lippincott Williams & Wilkins, Inc.