Endocrinol Metab.  2016 Mar;31(1):72-79. 10.3803/EnM.2016.31.1.72.

Well-Differentiated Thyroid Cancer: The Philippine General Hospital Experience

• Lo TE
• Uy AT
• Maningat P

• KMID: 2169695
• DOI: http://doi.org/10.3803/EnM.2016.31.1.72

Abstract

BACKGROUND
Well-differentiated thyroid cancer (WDTC) is the most common form of thyroid malignancy. While it is typically associated with good prognosis, it may exhibit higher recurrence and mortality rates in selected groups, particularly Filipinos. This paper aims to describe the experience of a Philippine Hospital in managing patients with differentiated thyroid cancer.
METHODS
We performed a retrospective cohort study of 723 patients with WDTC (649 papillary and 79 follicular), evaluating the clinicopathologic profiles, ultrasound features, management received, tumor recurrence, and eventual outcome over a mean follow-up period of 5 years.
RESULTS
The mean age at diagnosis was 44±13 years (range, 18 to 82), with a majority of cases occurring in the younger age group (<45 years). Most tumors were between 2 and 4 cm in size. The majority of papillary thyroid cancers (PTCs, 63.2%) and follicular thyroid cancers (FTCs, 54.4%) initially presented as stage 1, with a greater proportion of FTC cases (12.7% vs. 3.7%) presenting with distant metastases. Nodal metastases at presentation were more frequent among patients with PTC (29.9% vs. 7.6%). A majority of cases were treated by complete thyroidectomy, followed by radioactive iodine therapy and thyroid stimulating hormone suppression, resulting in a disease-free state. Excluding patients with distant metastases at presentation, the recurrence rates for papillary and FTC were 30.1% and 18.8%, respectively.
CONCLUSION
Overall, PTC among Filipinos was associated with a more aggressive and recurrent behavior. FTC among Filipinos appeared to behave similarly with other racial groups.

Keyword

Thyroid neoplasms; Thyroid cancer, papillary; Thyroid cancer, follicular

MeSH Terms

Cohort Studies
Diagnosis
Follow-Up Studies
Hospitals, General*
Humans
Iodine
Mortality
Neoplasm Metastasis
Prognosis
Recurrence
Retrospective Studies
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin
Ultrasonography
Iodine
Thyrotropin

Reference

1. Jarzab B, Slowinska-Klencka D. Commentary to the guidelines: "diagnosis and treatment of thyroid cancer". Endokrynol Pol. 2010; 61:569–574.

2. Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery. 2009; 145:514–518.

3. Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992-2006. Thyroid. 2011; 21:125–134.

4. Barczynski M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg. 2013; 100:410–418.

5. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011; 61:69–90.

6. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001; 86:1447–1463.

7. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006; 295:2164–2167.

8. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006; 154:787–803.

9. Kolonel LN. Cancer incidence among Filipinos in Hawaii and the Philippines. Natl Cancer Inst Monogr. 1985; 69:93–98.

10. Goodman MT, Yoshizawa CN, Kolonel LN. Descriptive epidemiology of thyroid cancer in Hawaii. Cancer. 1988; 61:1272–1281.

11. Haselkorn T, Bernstein L, Preston-Martin S, Cozen W, Mack WJ. Descriptive epidemiology of thyroid cancer in Los Angeles County, 1972-1995. Cancer Causes Control. 2000; 11:163–170.

12. Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, et al. Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst. 2013; 105:1096–1110.

13. Kus LH, Shah M, Eski S, Walfish PG, Freeman JL. Thyroid cancer outcomes in Filipino patients. Arch Otolaryngol Head Neck Surg. 2010; 136:138–142.

14. Clark JR, Eski SJ, Freeman JL. Risk of malignancy in Filipinos with thyroid nodules: a matched pair analysis. Head Neck. 2006; 28:427–431.

15. De La Pena AS. Thyroid cancer in the Philippines: an update. Acta Med Philipp. 1988; 9:38–42.

16. Amin A, Badwey A, El-Fatah S. Differentiated thyroid carcinoma: an analysis of 249 patients undergoing therapy and aftercare at a single institution. Clin Nucl Med. 2014; 39:142–146.

17. Sciuto R, Romano L, Rea S, Marandino F, Sperduti I, Maini CL. Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann Oncol. 2009; 20:1728–1735.

18. Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004; 130:819–824.

19. Kuijpens JL, Hansen B, Hamming JF, Ribot JG, Haak HR, Coebergh JW. Trends in treatment and long-term survival of thyroid cancer in southeastern Netherlands, 1960-1992. Eur J Cancer. 1998; 34:1235–1241.

20. Eichhorn W, Tabler H, Lippold R, Lochmann M, Schreckenberger M, Bartenstein P. Prognostic factors determining long-term survival in well-differentiated thyroid cancer: an analysis of four hundred eighty-four patients undergoing therapy and aftercare at the same institution. Thyroid. 2003; 13:949–958.

21. Holzer S, Reiners C, Mann K, Bamberg M, Rothmund M, Dudeck J, et al. Patterns of care for patients with primary differentiated carcinoma of the thyroid gland treated in Germany during 1996. U.S. and German Thyroid Cancer Group. Cancer. 2000; 89:192–201.

22. Chapter 341, Disorders of the thyroid gland. In : Longo DL, Kasper DL, Jameson JL, Fausi AS, Hauser SL, Loscalzo J, editors. Harrison's principles of internal medicine. 18th ed. New York: McGraw-Hill Medical;2012. p. 2936.

23. Sandeep TC, Strachan MW, Reynolds RM, Brewster DH, Scelo G, Pukkala E, et al. Second primary cancers in thyroid cancer patients: a multinational record linkage study. J Clin Endocrinol Metab. 2006; 91:1819–1825.

24. Baloch ZW, LiVolsi VA. Fine-needle aspiration of thyroid nodules: past, present, and future. Endocr Pract. 2004; 10:234–241.

25. Eilers SG, LaPolice P, Mukunyadzi P, Kapur U, Wendel Spiczka A, Shah A, et al. Thyroid fine-needle aspiration cytology: performance data of neoplastic and malignant cases as identified from 1558 responses in the ASCP Non-GYN Assessment program thyroid fine-needle performance data. Cancer Cytopathol. 2014; 122:745–750.

26. Morris LF, Ragavendra N, Yeh MW. Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg. 2008; 32:1253–1263.

27. Deveci MS, Deveci G, LiVolsi VA, Gupta PK, Baloch ZW. Concordance between thyroid nodule sizes measured by ultrasound and gross pathology examination: effect on patient management. Diagn Cytopathol. 2007; 35:579–583.

28. Baek SK, Jung KY, Kang SM, Kwon SY, Woo JS, Cho SH, et al. Clinical risk factors associated with cervical lymph node recurrence in papillary thyroid carcinoma. Thyroid. 2010; 20:147–152.

29. Ito Y, Kudo T, Kobayashi K, Miya A, Ichihara K, Miyauchi A. Prognostic factors for recurrence of papillary thyroid carcinoma in the lymph nodes, lung, and bone: analysis of 5,768 patients with average 10-year follow-up. World J Surg. 2012; 36:1274–1278.

30. Kim WG, Kim TY, Kim TH, Jang HW, Jo YS, Park YJ, et al. Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data. Korean J Intern Med. 2014; 29:325–333.

31. Asari R, Koperek O, Scheuba C, Riss P, Kaserer K, Hoffmann M, et al. Follicular thyroid carcinoma in an iodine-replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial. Ann Surg. 2009; 249:1023–1031.