TY - JOUR
T1 - Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996
T2 - An American college of surgeons commission on cancer patient care evaluation study
AU - Hundahl, Scott A
AU - Cady, Blake
AU - Cunningham, Myles P.
AU - Mazzaferri, Ernest
AU - McKee, Rosemary F.
AU - Rosai, Juan
AU - Shah, Jatin P.
AU - Fremgen, Amy M.
AU - Stewart, Andrew K.
AU - Hölzer, Simon
PY - 2000/7/1
Y1 - 2000/7/1
N2 - BACKGROUND. The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS. Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS. Of the 5584 cases of thyroid carcinoma, 81% were papillary, 0% follicular, 3.6% Hurthle cell, 0.5% familial medullary. 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS. In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes. [See commentary on pages 1-4, this issue and communication on pages 192-201, this issue. (C) 2000 American Cancer Society.
AB - BACKGROUND. The American College of Surgeons Commission on Cancer (CoC) has conducted national Patient Care Evaluation (PCE) studies since 1976. METHODS. Over 1500 hospitals with CoC-approved cancer programs were invited to participate in this prospective cohort study of U.S. thyroid carcinoma cases treated in 1996. Follow-up will be conducted through the National Cancer Data Base. RESULTS. Of the 5584 cases of thyroid carcinoma, 81% were papillary, 0% follicular, 3.6% Hurthle cell, 0.5% familial medullary. 2.7% sporadic medullary, and 1.7% undifferentiated/anaplastic. Demographics and suspected risk factors were analyzed. Fine-needle aspiration of the thyroid gland (53%) or a neck lymph node (7%), thyroid nuclear scan (39%), and ultrasound (38%) constituted the most frequently utilized diagnostic modalities. The vast majority of patients with differentiated thyroid carcinoma presented with American Joint Committee on Cancer Stage I and II disease and relatively small tumors. For all histologies, near-total or total thyroidectomy constituted the dominant surgical treatment. No lymph nodes were examined in a substantial proportion of cases. Residual tumor after the surgical event could be documented in 11% of cases, hypocalcemia in 10% of cases, and recurrent laryngeal nerve injury in 1.3% of cases. Complications were most frequently associated with total thyroidectomy combined with lymph node dissection. Thirty-day mortality was 0.3%; when undifferentiated/anaplastic cancer cases were eliminated, it decreased to 0.2%. Adjuvant treatment, probably underreported in this study, consisted of hormonal suppression (50% overall) and radioiodine (50% overall). CONCLUSIONS. In addition to offering information concerning risk factors and symptoms, the current PCE study compliments the survival information from previous NCDB reports and offers a surveillance snapshot of current management of thyroid carcinoma in the U.S. Identified opportunities for improvement of care include 1) more frequent use of fine-needle aspiration cytology in making a diagnosis; 2) more frequent use of laryngoscopy in evaluating patients preoperatively, especially those with voice change; and 3) improved lymph node resection and analysis to improve staging and, in some situations, outcomes. [See commentary on pages 1-4, this issue and communication on pages 192-201, this issue. (C) 2000 American Cancer Society.
KW - Adjuvant treatment
KW - Anaplastic cancer
KW - Complications
KW - Follicular carcinoma
KW - Hormonal therapy
KW - Hurthle cell carcinoma
KW - Iodine- 131
KW - Papillary carcinoma
KW - Surgery
KW - Thyroid carcinoma
KW - Undifferentiated cancer
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U2 - 10.1002/1097-0142(20000701)89:1<202::AID-CNCR27>3.0.CO;2-A
DO - 10.1002/1097-0142(20000701)89:1<202::AID-CNCR27>3.0.CO;2-A
M3 - Article
C2 - 10897019
AN - SCOPUS:17744412728
VL - 89
SP - 202
EP - 217
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 1
ER -