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- Title
Risk-stratified Management of Well-differentiated Thyroid Cancers: A Review of Experience from a Single Institution, 1990–2003.
- Authors
Chew, M. H.; Chan, G.; Siddiqui, M. M. A.; Tai, B. C.; Sivanandan, R.; Soo, K. C.; Lim, D. T. H.
- Abstract
Controversy persists regarding ideal management strategies in well-differentiated thyroid cancers (WDTC). This retrospective study reviews the utilization of a modified AMES risk stratification in the management of our institution’s patients. A total of 352 patients (median follow-up of 5.5 years) were reviewed and were risk stratified. Surgical resection was performed, and patients with clinically palpable lymph nodes were subjected to radical neck dissection. Patients were referred for adjuvant therapy if necessary. Of the 352 patients, 264 (75%) were females and 276 (78%) had papillary thyroid cancer (PTC). For those with lymph nodes (50%), 95% had PTC. In this series, 72% of the patients underwent total thyroidectomy; 5-year disease-free survival probability was 100% in low-risk patients, 92% in intermediate-risk patients, and 64% in high-risk patients. The 5-year overall survival probability was 100% in low-risk patients, 96% in intermediate-risk patients, and 69% in high-risk patients, respectively (both logrank trend p < 0.001). Management of WDTC requires multimodal treatment and should be based on patient risk classifications. We recommend aggressive surgical resection for all gross disease in high-risk and intermediate-risk patients. Adjuvant therapy is recommended in high-risk patients, but should be individualized for intermediate-risk patients. Total thyroidectomy may not be necessary in low-risk patients.
- Subjects
THYROID cancer; CANCER patients; NECK dissection; THYROIDECTOMY; DISEASE risk factors
- Publication
World Journal of Surgery, 2008, Vol 32, Issue 3, p386
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-007-9343-5