- 著者
- IWAO SUGITANI YOSHIHIDE FUJIMOTO
- 出版者
- (社)日本内分泌学会
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.46, no.1, pp.209-216, 1999 (Released:2006-11-25)
- 参考文献数
- 45
- 被引用文献数
- 69 127
Although the mortality rate associated with papillary microcarcinoma (PMC) of the thyroid generally is very low, some patients present with bulky nodal metastasis or distant metastasis and have an unfavorable prognosis. We retrospectively reviewed clinical aspects, surgical treatment and outcome of 178 patients with PMC in an attempt to determine the prognostic factors. The cause-specific 10-year survival rate was 96%. Three of four patients who showed signs of distant metastasis during the postsurgical period died of the disease, and another died of local recurrence. The most significant prognostic factors were the presence of clinically apparent lymph-node metastasis and hoarseness due to recurrent nerve palsy at the time of diagnosis. All distant metastases and cancer-specific deaths occurred in the 30 patients with symptomatic PMC who had either cervical lymphadenopathy, recurrent laryngeal nerve palsy or both. The 148 patients who had neither symptom had a distinctily favorable outcome. Total thyroidectomy followed by radioactive iodine treatment did not improve the final outcome in patients with symptomatic PMC. We conclude that patients with asymptomatic PMC can expect a truly favorable outcome, but some of those with symptomatic PMC may fall within a high-risk group of patients who do not benefit from aggressive treatment.
- 著者
- YOSHIHIDE FUJIMOTO IWAO SUGITANI
- 出版者
- (社)日本内分泌学会
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.45, no.4, pp.475-484, 1998 (Released:2006-11-25)
- 参考文献数
- 23
- 被引用文献数
- 10 12 18
We performed a long-term (35 to 45 year) follow-up study on patients who underwent surgery for intrathyroidal papillary thyroid carcinoma in order to reveal the natural history of the disease. Forty-nine patients underwent primary surgery for intrathyroidal papillary carcinoma during an 11-year period, 1950-1960. Various primary surgeries were performed, including neck exploration alone, tumor enucleation, hemi-, subtotal- and total-thyroidectomy in 2, 7, 21, 5 and 14 instances, respectively. Postoperative external irradiation was performed for most patients during the latter half of the period, and TSH suppression was carried out from 1956 through 1970. Follow-up studies were done in 1958, '62, '66, '69, '76 and currently 1997. Two patients, who had had only neck exploration and external irradiation, subsequently spent nearly normal lives for 10 and 32 years. Of the 28 patients who received hemithyroidectomy or lesser surgery, cancer recurrence in the remnant thyroid occurred in nine, of whom five received reoperation. At present, of all 49 patients, 22 are alive and well, and three are alive with asymptomatic recurrence. Only one male patient who had noted the initial lymph node metastases at age 15 died of bone metastasis 22 years after neck surgery. No other patients died definitely of thyroid cancer, although the causes of three deaths were unknown and one patient was lost after incomplete resection. The results of this study strongly support the idea that the majority of intrathyroidal papillary carcinomas remain non life-threatening for over 40 years and that they can be successfully treated by complete removal of macroscopic tumors by conservative surgery, hemi- or subtotal thyroidectomy, without associated adjuvant therapies.