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Rigshospitalet - a part of Copenhagen University Hospital
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Papillary thyroid carcinoma in Denmark, 1996-2008: outcome and evaluation of established prognostic scoring systems in a prospective national cohort

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  • Stefano Christian Londero
  • Annelise Krogdahl
  • Lars Bastholt
  • Jens Overgaard
  • Henrik Baymler Pedersen
  • Christoffer Holst Hahn
  • Jens Bentzen
  • Sten Schytte
  • Peer Christiansen
  • Oke Gerke
  • Christian Godballe
  • Danish Thyroid Cancer Group-DATHYRCA (part of the DAHANCA organization)(Birte Nygaard, Peter Oturai, members)
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BACKGROUND: Regional as well as national series show an increasing incidence of thyroid cancer largely small size papillary thyroid carcinoma (PTC). Prognostic scoring systems have been developed, but these do not take into account the rapidly changing case mix, and adjustments may be required. The purposes of this study were to evaluate treatment outcomes and to analyze the value of older prognostic scoring systems tested on a relatively new, unselected national cohort of PTC patients.

METHODS: This was a national prospective cohort study conducted in Denmark, which has a population of 5.5 million.

RESULTS: A total of 1350 patients were diagnosed with PTC during 1996-2008, and the median follow-up time was 7.9 years. The 10-year recurrence-free survival rate was 90.2%, and the 10-year crude and cause-specific survival (CSS) rates were 83.7% and 93.8% respectively. By multivariate Cox regression, it was possible to confirm age, metastases (distant and nodal), extrathyroidal extension, and tumor size as predictors of mortality, whereas only nodal metastases, extrathyroidal extension, and tumor size were predictors of recurrence. In analyses of older prognostic scoring systems, a significant correlation between the risk group ranks was found for survival as well as recurrence. The c-index for CSS was highest for MACIS (0.92) and lowest for AMES (0.80). In the TNM, MACIS, and EORTC systems, most patients were classified as stage 1, and for these patients, the 10-year CSS rate was approximately 99.5%, confirming the generally excellent survival.

CONCLUSION: This national study provides further evidence that a favorable prognosis is to be expected for patients diagnosed with PTC. Also, it was possible to confirm age, metastases, extrathyroidal extension, and tumor size as predictors of mortality, whereas only nodal metastases, extrathyroidal extension, and tumor size were predictors of recurrence. All the scoring systems evaluated were able to produce a highly significant risk group stratification, showing that in spite of the changes in the case mix of PTC, these systems are still applicable, and in fact contain valuable prognostic information useable for treatment planning.

Original languageEnglish
JournalThyroid : official journal of the American Thyroid Association
Volume25
Issue number1
Pages (from-to)78-84
Number of pages7
ISSN1050-7256
DOIs
Publication statusPublished - Jan 2015

ID: 45026834