Differentiated thyroid carcinoma: Long term results of a management protocol based on simple prognostic criteria

OBJECTIVES: To study the longterm results of an aggressive management protocol based on a new-simple classification and to determine the duration for patient follow-up according to this classification. MATERIAL AND METHODS: For the 509 patients with differentiated thyroid carcinoma, the classification was: group 1. cancer<1 cm (n=117), group 2A: cancer without extension in patients of age less than 45 years (n=100), group 28: cancer without extension in patients aged more than 45 (n = 94), group 3: cancer with nodal extension alone (n=102), group 4: high risk cancer in patients having either distant metastases or local tissular extension or in whom after iodine-131 ablation, Tg level was >3 mu g/l off hormone therapy (n=96). Total thyroidectomy was the rule except for group 1 and some patients of group 2A in whom the tumor was solitary, relatively small, well-differentiated, with no capsular or capillary invasion. iodine 131 ablation was carried out after a total thyroidectomy and repeat treatments with iodine 131 were given whenever necessary. RESULTS: In group 1,2A and 3, the 20 years death rate of cancer was O p. 100. For group 28, patients cancer death rate was 8 p. 100 and for group 4 it was 32 p. 100. Distant metastases were the cause of death except for one patient who died from local recurrence. Clinical inspection, Tg measurement, iodine 131 whole-body scan and chest-Xray were all useful in discovering local or distant recurrences. CONCLUSION: Our results justify the use of an aggressive initial management for differentiated thyroid carcinoma and an appropriate scoring system. When this protocol is applied, patients of group 1, 2 and 3 should have an excellent prognosis. However patients followup should not be shorter than 15 years for patients of group 1 and 2A and than 20 years for all other groups.