Risk stratification of patients with locally aggressive differentiated thyroid cancer

Summary

The Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined group of patients with locally aggressive thyroid carcinomas (pT4; AJCC/UICC 1997). The aim of the present study was to compare the survival of patients with minimum and extensive extrathyroidal growth according to the new AJCC/UICC TNM staging system 2009. Patients, methods: The followup data of 347 patients were analysed. Patients were reclassified according to the current AJCC/UICC 2009 classification. The event-free and overall survival was evaluated using Kaplan-Meier analysis. In addition, postoperative complications and status of disease were documented. Results: 327 patients were assigned to stage pT3 and 20 patients to stage pT4a, respectively. Median follow-up was 6.1 years (range 0.04–9.8 years). 92.5% of patients reached complete remission. There were 7.8 % recurrences in the thyroid bed, in locoregional lymph nodes and/or in distant sites. The overall survival was >98% both in pT3 and pT4a patients (p = n. s.). In contrast, the event-free survival was significantly less favourable in pT4a patients (p < 0.001). Using multivariate analysis the following parameters were significant predictors of event-free survival: histological tumour type, degree of extrathyroidal extension and nodal metastasis (p < 0.05). Conclusions: The MSDS patients with locally aggressive differentiated thyroid cancer showed an excellent overall survival during a median follow-up of 6.1 years. According to the current AJCC/UICC 2009 classification, pT3 patients with minimal extra thyroidal extension revealed a significantly better event-free survival than pT4a patients with extensive extrathyroidal growth.

Zusammenfassung

Die Multizenter Studie Differenziertes Schilddrüsenkarzinom (MSDS) umfasst eine präzise definierte Gruppe von Patienten mit lokal aggressiven Schilddrüsenkarzinomen (pT4; AJCC/ UICC 1997). Ziel war es, das Überleben der Patienten mit minimalem und ausgedehnten extrathyreoidalen Wachstum nach der neuen AJCC/UICC TNM Klassifikation von 2009 zuvergleichen. Patienten, Methodik: Die Daten von 347 Patienten wurde ausgewertet. Dazu wurden die Patienten nach der neuen AJCC/ UICC TNM Klassifikation von 2009 reklassifiziert. Mittels Kaplan-Meier Analyse wurden das Ereignis-freie und Gesamt-Überleben evaluiert. Zusätzlich wurden die perioperativen Komplikationen und der Status der Erkrankung dokumentiert. Ergebnisse: 327 Patienten wurden dem Stadium pT3 und 20 Patienten dem Stadium pT4a zugeordnet. Der mediane Nachsorge-Zeitraum betrug 6.1 Jahre (0.04–9.8 Jahre). 92.5% der Patienten erreichten eine komplette Remission. Bei 7.8 % der Patienten fanden sich Rezidive im Schilddrüsenbett, den lokoregionalen Lymphknoten und/oder Fernmetastasen. Das Gesamt-Überleben betrug sowohl für Patienten mit pT3– als auch pT4a-Tumoren >98% (p = n. s.). Im Gegensatz dazu war das Ereignis-freie Überleben der pT4-Patienten signifikant schlechter (p < 0.001). Nach multivariater Analyse waren die folgenden Parameter signifikante Prädiktoren des Ereignis-freien Überlebens: Histopathologie, Ausmaß des extrathyreoidalen Wachstums und Lymphknonten-Metastasierung (p < 0.05). Schlussfolgerungen: Während einer medianen Nachsorge von 6.1 Jahren zeigten die MSDS Patienten mit lokal aggressiven differenzierten Schilddrüsenkarzinomen ein exzellentes Gesamt-Überleben. Nach der aktuellen AJCC/UICC Klassifikation von 2009 wiesen Patienten mit pT3-Tumoren und minimalem extrathyreoidalen Wachstum ein signifikant besseres Ereignis-freies Überleben auf als Patienten mit pT4-Tumoren und ausgedehnten extra thyreoidalen Tumoranteilen.

Keywords

Thyroid carcinomas - risk stratification - MSDS trial

Schlüsselwörter

Schilddrüsenkrebs - Risikostratifizierung - MSDS

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