Surgical treatment for thyroid carcinoma: retrospective study with 811 patients in a Brazilian tertiary hospital

Cavalheiro, Beatriz G.; Matos, Leandro L.; Leite, Ana Kober N.; Kulcsar, Marco Aurélio V.; Cernea, Claudio R.; Brandão, Lenine G.

doi:10.1590/2359-3997000000209

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Original Articles • Arch. Endocrinol. Metab. 60 (5) • Oct 2016 • https://doi.org/10.1590/2359-3997000000209 copy

Surgical treatment for thyroid carcinoma: retrospective study with 811 patients in a Brazilian tertiary hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

The aim of the present study was to describe the epidemiologic data, histological type, treatment and follow-up of the 811 patients treated for thyroid cancer in Instituto do Câncer do Estado de São Paulo (ICESP) over 5 years.

Materials and methods

Retrospective analyses of electronic chart information.

Results

There were 679 cases (83.7%) of papillary thyroid cancer, 61 (7.5%) of follicular carcinoma, 54 (6.7%) of medullary carcinoma, 11 (1.4%) of poorly differentiated carcinoma and 6 of anaplastic carcinoma (0.7%). The majority of patients were female (82.2%), and the mean age was 50.5 ± 15 years. Two hundred forty-two patients had disease persistence or recurrence. At the last follow-up, 629 (77.6%) patients were alive and disease free, 141 (17.4%) were alive with disease, and 41 (5.1%) were deceased, with 37 deaths related to thyroid cancer.

Conclusion

This study was able to outline the profile, disease type and evolution of patients treated for thyroid cancer at a single tertiary hospital.

Thyroid diseases; thyroid neoplasms; epidemiology; prognosis

p Stage	N (%)	Age range (years)	Mean age (year)	Female sex	Mean diameter (cm)	Iodotherapy	Cervical recurrence	Distant metastasis	Disease persistence	Alive (disease free)	Alive (with disease)	Death
Papillary carcinoma (N = 679)

pT1a N0	205 (30.2%)	20-82	52.7	184 (89.8%)	0.5	28 (13.66%)	7 (3.4%)	0 (0.0%)	0 (0.0%)	203 (99.0%)	2 (0.8%)	0 (0.0%)
pT1b N0	88 (13.0%)	20-78	49.6	75 (85.2%)	1.4	57 (64.77%)	10 (11.4%)	3 (3.4%)	0 (0.0%)	83 (94.3%)	3 (3.4%)	2 (2.27%)
pT1a N1a	8 (1.2%)	21-48	34.6	6 (75.0%)	0.5	5 (62.5%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	8 (100.0%)	0 (0.0%)	0 (0.0%)
pT1a N1b	6 (0.9%)	26-68	47.0	5 (83.3%)	0.8	6 (100.0%)	2 (33.3%)	0 (0.0%)	0 (0.0%)	6 (100.0%)	0 (0.0%)	0 (0.0%)
pT1b N1a	10 (1.5%)	20-71	42.5	8 (80.0%)	1.5	9 (90.0%)	1 (10.0%)	0 (0.0%)	0 (0.0%)	10 (100.0%)	0 (0.0%)	0 (0.0%)
pT1b N1b	9 (1.3%)	21-50	37.3	6 (66.7%)	1.5	9 (100.0%)	0 (0.0%)	1 (11.1%)	0 (0.0%)	8 (88.9%)	0 (0.0%)	1 (11.11%)
pT2 N0	48 (7.1%)	22-84	48.8	42 (87.5%)	2.8	40 (83.33%)	4 (8.3%)	1 (2.1%)	0 (0.0%)	47 (97.9%)	1 (2.1%)	0 (0.0%)
pT2 N1a	7 (1.0%)	14-87	39.7	4 (57.1%)	2.3	7 (100.0%)	3 (42.9%)	0 (0.0%)	0 (0.0%)	5 (71.4%)	2 (28.6%)	0 (0.0%)
pT2 N1b	5 (0.7%)	22-72	50.2	3 (60.0%)	2.5	4 (57.14%)	1 (20.0%)	1 (20.0%)	0 (0.0%)	5 (100.0%)	0 (0.0%)	0 (0.0%)
pT3 N0	141 (20.8%)	18-87	51.9	121 (85.8%)	2.3	122 (86.52%)	10 (7.1%)	6 (4.3%)	0 (0.0%)	132 (93.6%)	7 (5.0%)	1 (0.71%)
pT3 N1a	37 (5.4%)	19-80	46.8	34 (91.9%)	2.3	37 (100.0%)	12 (32.4%)	4 (10.8%)	0 (0.0%)	30 (81.1%)	4 (10.8%)	3 (8.11%)
pT3 N1b	39 (5.7%)	20-73	46.4	33 (84.6%)	3.0	36 (92.30%)	11 (28.2%)	5 (12.8%)	1 (2.6%)	27 (69.2%)	11 (28.2%)	1 (2.57%)
pT4aN0	7 (1.0%)	22-81	50.3	4 (57.1%)	6.7	7 (100.0%)	1 (14.3%)	3 (42.9%)	0 (0.0%)	6 (85.7%)	1 (14.3%)	0 (0.0%)
pT4a N1a	8 (1.2%)	44-65	58.0	5 (62.5%)	5.0	8 (100.0%)	1 (12.5%)	3 (37.5%)	3 (37.5%)	3 (37.5%)	4 (50.0%)	1 (12.5%)
pT4a N1b	14 (2.1%)	13-69	42.3	8 (57.1%)	4.5	12 (85.71%)	9 (64.3%)	4 (28.6%)	3 (21.4%)	6 (42.9%)	6 (42.9%)	2 (14.28%)
pT4b N0	3 (0.4%)	43, 54, 73	56.7	2 (66.7%)	9.8	2 (66.67%)	3 (100.0%)	2 (66.7%)	3 (100.0%)	0 (0.0%)	2 (66.7%)	1 (33.33%)
pT4b N1a	2 (0.3%)	4, 64	52.5	1 (50.0%)	8.0	0 (0.0%)	0 (0.0%)	1 (50.0%)	2 (100.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)
pT4b N1b	2 (0.3%)	50, 70	60.0	0 (0.0%)	5.0	1 (50.0%)	0 (0.0%)	2 (100.0%)	2 (100.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)
Missing stage	40 (5.9%)	19-78	47.7	31 (77.5%)	-	27 (67.50%)	12 (30.0%)	14 (2.1%)	5 (12.5%)	15 (37.5%)	22 (55.0%)	3 (7.50%)
Total	679 (83.72%)	20-84	48.2	572 (84.24%)	3.4	419 (61.71%)	87 (12.81%)	50 (7.36%)	19 (2.80%)	594 (87.48%)	67 (9.87%)	16 (2.36%)

Follicular carcinoma (N = 61)

pT1 N0	10 (16.4%)	31-82	58.0	9 (90.0%)	1.4	5 (50.0%)	1 (10.0%)	3 (30.0%)	0 (0.0%)	7 (70%)	2 (20%)	1 (10%)
pT1 N1a	1 (1.6%)	38	38.0	1 (100.0%)	1.5	1 (100.0%)	1 (100.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)	0 (0.0%)
pT2 N0	13 (21.3%)	19-75	48.8	11 (84.6%)	2.5	10 (76.9%)	0 (0.0%)	2 (15.4%)	1 (76.9%)	11 (84.6%)	2 (15.4%)	0 (0.0%)
pT3 N0	12 (19.7%)	32-81	60.5	10 (83.3%)	4.2	12 (100.0%)	2 (16.7%)	5 (41.7%)	0 (0.0%)	7 (58.3%)	4 (33.3%)	1 (8.3%)
pT3 N1a	2 (3.3%)	70-73	71.5	2 (100.0%)	7.3	1 (50.0%)	1 (50.0%)	2 (100.0%)	0 (0.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)
pT3 N1b	1 (1.6%)	76	76.0	0 (0.0%)	10.5	1 (100.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)	0 (0.0%)
pT4 N0	2 (3.3%)	61, 75	68.0	1 (50.0%)	6.1	2 (100.0%)	0 (0.0%)	1 (50.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)	0 (0.0%)
pT4 N1	2 (3.3%)	39, 69	54.0	2 (100.0%)	2.4	2 (100.0%)	1 (50.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)
Missing stage	18 (29.5%)	39-84	64.4	12 (66.7%)	-	9 (50.0%)	5 (27.8%)	11 (61.1%)	4 (22.2%)	3 (16.7%)	12 (66.7%)	2 (11.1%)
Total	61 (7.52%)	19-84	59.9	48 (78.69%)	4.5	43 (70.49%)	12 (19.67%)	26 (42.62%)	6 (9.83%)	29 (47.54%)	25 (40.98%)	7 (11.47%)

Medulary carcinoma (N = 54)

pT1 N0	2 (3.7%)	37, 52	44.5	2 (100.0%)	0.6	0 (0.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)	0 (0.0%)
pT1 N1b	5 (9.3%)	16-66	37.4	2 (40.0%)	1.1	2 (40.0%)	2 (40.0%)	3 (60.0%)	4 (80.0%)	1 (20.0%)	3 (60.0%)	1 (20.0%)
pT2 N0	3 (5.6%)	47, 56, 66	56.3	3 (100.0%)	3.4	1 (33.3%)	0 (0.0%)	1 (33.3%)	0 (0.0%)	2 (66.7%)	1 (33.3%)	0 (0.0%)
pT2 N1b	4 (7.4%)	13-61	31.8	4 (100.0%)	3.5	2 (50.0%)	2 (50.0%)	2 (50.0%)	3 (75.0%)	0 (0.0%)	4 (100.0%)	0 (0.0%)
pT3 N1b	10 (18.5%)	8-72	53.8	4 (40.0%)	4.0	5 (50.0%)	0 (0.0%)	8 (80.0%)	10 (100.0%)	0 (0.0%)	9 (90.0%)	1 (10.0%)
pT4a N1b	11 (20.4%)	21-72	42.3	5 (45.5%)	4.5	6 (54.5%)	0 (0.0%)	9 (81.8%)	11 (100.0%)	0 (0.0%)	9 (81.8%)	2 (18.2%)
Missing stage	19 (35.2%)	14-78	41.1	11 (57.9%)	-	11 (57.9%)	6 (31.6%)	14 (73.7%)	12 (63.2%)	0 (0.0%)	16 (84.2%)	3 (15.8%)
Total	54 (6.66%)	8-78	43.9	31 (57.40%)	2.9	27 (50.00%)	11 (20.37%)	37 (68.52%)	40 (68.96%)	4 (7.41%)	43 (79.63%)	7 (11.86%)

Poorly differentiated carcinoma (N = 11)

pT2 N0	1 (9.1%)	72	72.0	1 (100.0%)	2.5	0 (0.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
pT2 N1	1 (9.1%)	44	44.0	1 (100.0%)	3.0	1 (100.0%)	1 (100.0%)	1 (100.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
pT3 N0	2 (18.2%)	63, 67	65.0	0 (0.0%)	8.4	2 (100.0%)	0 (0.0%)	1 (50.0%)	1 (50.0%)	0 (0.0%)	0 (0.0%)	1 (50.0%)
p T4a N1b	5 (45.5%)	49, 84	60.6	3 (60.0%)	8.7	3 (60.0%)	0 (0.0%)	1 (20.0%)	5 (100.0%)	0 (0.0%)	4 (80.0%)	1 (20.0%)
pT4b	1 (9.1%)	72	72.0	1 (100.0%)	6.0	1 (100.0%)	0 (0.0%)	1 (100.0%)	1 (100.0%)	0 (0.0%)	0 (0.0%)	1 (100.0%)
Missing stage	1 (9.1%)	44	44.0	1 (100.0%)	-	1 (100.0%)	1 (100.0%)	1 (100.0%)	1 (100.0%)	0 (0.0%)	1 (100.0%)	0 (0.0%)
Total	11 (1.36%)	44-84	59.6	7 (63.64%)	5.7	8 (72.72%)	3 (27.27%)	5 (45.45%)	9 (81.82%)	1 (9.09%)	5 (45.45%)	4 (36.36%)

Anaplastic carcinoma (N = 6)

IV B	2 (33.3%)	66, 74	70.0	1 (50.0%)	-	0 (0.0%)	0 (0.0%)	0 (0.0%)	2 (100.0%)	0 (0.0%)	0 (0.0%)	2 (100.0%)
IV C	4 (66.7%)	44-72	57.8	1 (25%)	-	3 (75.0%)	-	4 (100.0%)	4 (100.0%)	0 (0.0%)	2 (50.0%)	2 (50.0%)
Total	6 (0.74%)	44-74	63.0	2 (33.33%)	-	3 (50.00%)	0 (0.00%)	66.67%	6 (100.00%)	0.00%	33.33%	66.67%

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[1] Correspondence to: Beatriz G. Cavalheiro. Av. Dr. Enéas de Carvalho Aguiar, 255, 8º andar, sala 8174. 05403-000 – São Paulo, SP, Brasil. bgcavalheiro@yahoo.com.br