Archive of Oncology (Jan 2003)
Differentiated thyroid carcinomas and regional metastases
Abstract
Background: Aim of the study was to determine the frequency of regional nodal metastases (N1) of differentiated thyroid carcinomas (DTC), to analyze the modes of treatment, course of disease, and outcome. Methods: In Department of Nuclear Medicine in Sremska Kamenica, 363 DTC patients were treated from 1977 to the end of 2000. Nodal metastases had 182 patients most of them were followed to the end of 2000. Methods: All patients with N1 were treated surgically (operation of thyroid gland was done in all patients, surgical treatment of lymph nodes in 80.2% of them), afterwards by radioiodine and long-life by hormonal therapy; external beam therapy was applied in 9.9% of patients, chemotherapy in 1.6% of patients. The range of follow-up was from 2 months to 24.2 years, the mean 4.7 years. Results Nodal metastases were detected first, before primary tumor, in 21.9% patients, and simultaneously in 63.2% patients. They appeared subsequently after detection and initial treatment of primary tumor in 14.8% patients the incomplete initial therapy in this subgroup of patients was more frequent than complete therapy (p<0.01). Regional metastases N1b were present more frequently than N1a (p<0.001). Distant metastases (M1) in N1 group were discovered in 27.5% of patients; they were more frequent than in N0 group of patients (p<0.001). Nodal metastases were found more frequently in the group of papillary than in the group of follicular carcinoma (p<0.001), and in the men than in the women with DTC (p<0.001). Remission was achieved in 67.7% of patients with N1. Disease related deaths occurred in 15.8% of patients with N1; M1 was cause of deaths in 10.2% of patients locoregional disease (T4 and/or N1) in 5.9% of patients, and M1+extended T4 and/or N1 in 0.7% of patients. Late complications of treatment caused the death in 2.1% of patients with N1. The relapses of disease occurred in 31.9% of patients. The survival probability after onset of the nodal disease in N1M0 subgroup was 0.88+/-0.05 after 10 years, and 0.64+/-0.16 after 20 years; the probability of survival was very significantly shorter when M1 were present (p<0.001). Conclusion: Regional metastases were detected in the half of DTC patients. The detection of N1 was the first indicator of thyroid tumor in about 20% of them. Nodal metastases grew later on after detection and initial treatment of primary tumor in about 15% of patients, mostly as a result of inadequate treatment. The frequency of N1 was greater in patients with papillary type of tumor and in males. The presence of M1 had significant influence on survival of patients with N1.
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