Multiparameter scoring system for the prognosis of differentiated thyroid cancer

Summary

The aim of the study was to develop a scoring system consisting of multiple parameters that are significant for prognosis of thyroid cancer. The score was designed to permit a risk stratification with all available information at any time of presentation. Patients, methods: A score using 25 parameters was used for 171 patients with differentiated thyroid cancer, who were included in follow up over a mean of 9 (± 5) years. The significance of each parameter as well as of a summation outcome score was determined. The result of this scoring system was compared to other scores reported in the literature applied to the same patients' group. Thirty-two out of the 171 patients presented with recurrence during follow up. Results: The summation score was highly significant for prognosis of differentiated thyroid cancer. Out of 25 parameters, 18 showed a significant association with outcome also as individual parameters. In comparison to the scores commonly used, this new system showed the highest significance (p < 0.0001, chi square 90, df 1) to estimate recurrence free survival. At a cutoff of –5.95 the sensitivity and specificity for the distinction between high and low risk patients were 87.5 and 77.0%, respectively. Conclusion: With our multiparameter scoring system a reliable prognosis with respect to recurrence free survival is possible in patients suffering from differentiated thyroid cancer. A summation score of all parameters gives the best results. Scoring is also possible, if several important parameters are missing.

Zusammenfassung

Ziel der Studie war die Entwicklung eines Scoresystems aus multiplen Parametern, die für die Prognose des differenzierten Schilddrüsenkarzinoms relevant sind. Der Score soll zu jedem Zeitpunkt der Vorstellung des Patienten eine Prognosestellung anhand der vorhandenen Parameter ermöglichen. Patienten, Methodik: Ein Score aus 25 Parametern wurde auf 171 Patienten mit differenziertem Schilddrüsenkarzinom angewendet, die über im Mittel 9 (±5) Jahre beobachtet wurden. Die Signifikanz jedes Einzelparameters sowie eines Summationsscores wurden bestimmt. Die Ergebnisse dieses Scores wurden anhand des gleichen Patientenkollektivs mit anderen Systemen aus der Literatur verglichen. Ein Rezidiv zeigte sich bei 32 der 171 Patienten. Ergebnisse: Der Summationsscore war hoch signifikant für die Prognose des differenzierten Schilddrüsenkarzinoms. Von den 25 Parametern zeigten 18 auch als Einzelparameter einen signifikanten Zusammenhang mit dem Verlauf. Im Vergleich zu den üblichen Scores zeigte dieses System die höchste Signifikanz (p < 0.0001, chi2 90, df 1) bei der Abschätzung des rezidivfreien überlebens. Bei einem Cut-off von –5.95 betrug für die Unterscheidung zwischen Patienten mit hohem und niedrigem Risiko die Sensitivität 87.5% und die Spezifität 77.0%. Schlussfolgerung: Dieses Multiparameter-Scoresystem erlaubt eine zuverlässige Prognose des rezidivfreien überlebens bei Patienten mit differenziertem Schilddrüsenkarzinom. Der Summationsscore liefert die besten Ergebnisse. Die Angabe eines Scores ist auch möglich, wenn relevante Parameter fehlen.

Keywords

Differentiated thyroid carcinoma - prognosis - prediction - cancer - oncology

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - Prognose - Vorhersagewert - Karzinom - Onkologie

• References

• 1 AL-Nahhas A. Dedifferentiated thyroid carcinoma: the imaging role of ¹⁸F-FDG PET and non- iodine radiopharmaceuticals. Nucl Med Commun 2004; 25: 891-895.
• 2 Biermann M, Schober O. How many patients with differentiated thyroid cancer need a “Tumor Center” per year?. Nuklearmedizin 2002; 41: 61-62.
• 3 Byar DP, Green SB, Dor P. et al. A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group. Eur JCancer 1979; 15: 1033-1041.
• 4 Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988; 104: 947-953.
• 5 D'Avanzo A, Ituarte P, Treseler P. et al. Prognostic scoring systems in patients with follicular thyroid cancer: a comparison of different staging systems in predicting the patient outcome. Thyroid 2004; 14: 453-458.
• 6 Davis NL, Bugis SP, McGregor GI. et al. An evaluation of prognostic scoring systems in patients with follicular thyroid cancer. Am J Surg 1995; 170: 476-480.
• 7 Dietlein M, Schober O, Schicha H. Overtherapyor undertherapy for papillary thyroid microcarcinoma? Therapeutic considerations for radioiodine ablation. Nuklearmedizin 2004; 43: 107-114.
• 8 Evans HL. Encapsulated columnar-cell neoplasms of the thyroid. A report of four cases suggesting a favorable prognosis. Am J Surg Pathol 1996; 20: 1205-1211.
• 9 Feine U, Lietzenmayer R, Hanke JP. et al. ¹⁸FDG whole-body PET in differentiated thyroid carcinoma. Flipflop in uptake patterns of ¹⁸FDG and ¹³¹I. Nuklearmedizin 1995; 34: 127-134.
• 10 Grünwald F, Menzel C, Fimmers R. et al. Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer. J Nucl Med 1996; 37: 1962-1964.
• 11 Ito Y, Matsuzuka F, Yoshida H. et al. Encapsulated anaplastic thyroid carcinoma without invasive phenotype with favorable prognosis: report of a case. Surg Today 2003; 33: 277-281.
• 12 Hay ID, Bergstralh EJ, Goellner JR. et al. Predicting outcome in papillary thyroid carcinoma: development of areliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993; 114: 1050-1057.
• 13 Hay ID, Grant CS, Taylor WF. et al. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: aretrospective analysis of surgical outcome using anovel prognostic scoring system. Surgery 1987; 102: 1088-1095.
• 14 Hundahl SA, Fleming ID, Fremgen AM. et al. A National Cancer Data Base report on53 856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer 1998; 83: 2638-2648.
• 15 Kim TY, Kim WB, Kim ES. et al. Serum thyroglobulin levels at the time of ¹³¹I remnant ablationjust after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2005; 90: 1440-1445.
• 16 Lin JD, Huang MJ, Hsu BR. et al. Significance of postoperative serum thyroglobulin levels in patients with papillary and follicular thyroid carcinomas. J Surg Oncol 2002; 80: 45-51.
• 17 Liu J, Singh B, Tallini G. et al. Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer 2006; 107: 1255-1264.
• 18 Nemec J, Zamrazil V, Pohunkova D. et al. Radio- iodide treatment of pulmonary metastases of differentiated thyroid cancer. Results and prognostic factors. Nuklearmedizin 1979; 18: 86-90.
• 19 Robbins RJ, Wan Q, Grewal RK. et al. Real-time Prognosis for metastatic thyroid carcinoma based on FDG-PET scanning. J Clin Endocrinol Metab 2006; 91: 498-505.
• 20 Sophocleous S, Ehrenheim C, Fischer J. et al. Low- risk thyroid carcinoma - therapy, follow-up and prognosis. Nuklearmedizin 1997; 36: 93-102.
• 21 Verburg FA, de Keizer B, Lips CJ. et al. Prognostic significance of successful ablation with radio- iodine of differentiated thyroid cancer patients. Eur J Endocrinol 2005; 152: 33-37.
• 22 Wang W, Larson SM, Fazzari M. et al. Prognostic value of [¹⁸F]fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab 2000; 85: 1107-1113.
• 23 Yunta PJ, Ponce JL, Prieto M. et al. The importance of a tumor capsule in columnar cell thyroid carcinoma: a report of two cases and review of the literature. Thyroid 1999; 9: 815-819.