TY - JOUR
T1 - Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999)
T2 - Temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients
AU - Hay, Ian D.
AU - Thompson, Geoffrey B.
AU - Grant, Clive S.
AU - Bergstralh, Eric J.
AU - Dvorak, Catherine E.
AU - Gorman, Colum A.
AU - Maurer, Megan S.
AU - McIver, Bryan
AU - Mullan, Brian P.
AU - Oberg, Ann L.
AU - Powell, Claudia C.
AU - Van Heerden, Jon A.
AU - Goellner, John R.
PY - 2002/8
Y1 - 2002/8
N2 - It is uncertain whether more extensive primary surgery and increasing use of radioiodine remnant ablation (RRA) for papillary thyroid carcinoma (PTC) have resulted in improved rates of cause-specific mortality (CSM) and tumor recurrence (TR). Details of the initial presentation, therapy, and outcome of 2444 PTC patients consecutively treated during 1940-1999 were recorded in a computerized database. Patients were followed for more than 43,000 patient-years. The 25-year rates for CSM and TR were 5% and 14%, respectively. Temporal trends were analyzed for six decades. During the six decades, the proportion with initial MACIS (distant Metastasis, patient Age, Completeness of resection, local Invasion, and tumor Size) scores < 6 were 77%, 82%, 84%, 86%, 85%, and 82%, respectively (p = 0.06). Lobectomy accounted for 70% of initial procedures during 1940-1949 and 22% during 1950-1959; during 1960-1999 bilateral lobar resection (BLR) accounted for 91% of surgeries (p < 0.001). RRA after BLR was performed during 1950-1969 in 3% but increased to 18%, 57%, and 46% in successive decades (p < 0.001). The 40-year rates for CSM and TR during 1940-1949 were significantly higher (p = 0.002) than during 1950-1999. During the last 50 years the 10-year CSM and TR rates for the 2286 cases did not significantly change with successive decades. Moreover, the 10-year rates for CSM and TR were not significantly improved during the last five decades of the study, either for the 1917 MACIS < 6 patients or the 369 MACIS ≥ 6 patients. Increasing use of RRA has not apparently improved the already excellent outcome, achieved before 1970, in low risk (MACIS < 6) PTC patients managed by near-total thyroidectomy and conservative nodal excision.
AB - It is uncertain whether more extensive primary surgery and increasing use of radioiodine remnant ablation (RRA) for papillary thyroid carcinoma (PTC) have resulted in improved rates of cause-specific mortality (CSM) and tumor recurrence (TR). Details of the initial presentation, therapy, and outcome of 2444 PTC patients consecutively treated during 1940-1999 were recorded in a computerized database. Patients were followed for more than 43,000 patient-years. The 25-year rates for CSM and TR were 5% and 14%, respectively. Temporal trends were analyzed for six decades. During the six decades, the proportion with initial MACIS (distant Metastasis, patient Age, Completeness of resection, local Invasion, and tumor Size) scores < 6 were 77%, 82%, 84%, 86%, 85%, and 82%, respectively (p = 0.06). Lobectomy accounted for 70% of initial procedures during 1940-1949 and 22% during 1950-1959; during 1960-1999 bilateral lobar resection (BLR) accounted for 91% of surgeries (p < 0.001). RRA after BLR was performed during 1950-1969 in 3% but increased to 18%, 57%, and 46% in successive decades (p < 0.001). The 40-year rates for CSM and TR during 1940-1949 were significantly higher (p = 0.002) than during 1950-1999. During the last 50 years the 10-year CSM and TR rates for the 2286 cases did not significantly change with successive decades. Moreover, the 10-year rates for CSM and TR were not significantly improved during the last five decades of the study, either for the 1917 MACIS < 6 patients or the 369 MACIS ≥ 6 patients. Increasing use of RRA has not apparently improved the already excellent outcome, achieved before 1970, in low risk (MACIS < 6) PTC patients managed by near-total thyroidectomy and conservative nodal excision.
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U2 - 10.1007/s00268-002-6612-1
DO - 10.1007/s00268-002-6612-1
M3 - Article
C2 - 12016468
AN - SCOPUS:0036691093
SN - 0364-2313
VL - 26
SP - 879
EP - 885
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 8
ER -