ABSTRACT
Eighty-one patients with thyroid carcinoma have been treated at King Abdul Aziz Hospital and Oncology Center, Jeddah, KSA between 1992 and January 2000. They were referred postoperatively to Oncology Center for radioiodine ablation, hormone suppression +/- external irradiation. Their mean age was 39 years, with a peak in the 4th decade and follicular carcinoma patients were older than those with papillary carcinoma [median 42 Vs 35]. Females represented 76.6%, with female to male ratio 3.2:1. Diagnostic work up revealed that only 22.2% performed fine needle aspiration [FNA], 37% performed preoperative thyroid scan and 92.5% performed thyroid ultrasonography. Papillary carcinoma represented 84% Vs 12% for follicular carcinoma and the rest were medullary and anaplastic carcinoma. Survival analysis was performed for differentiated thyroid carcinoma patients only [78 patients]. Over a mean follow up of 42.6 months, the mean values for locoregional free survival was 35.4 months, distant metastases free survival was 38.1 months and overall survival was 38.5 months. Correlation of survival parameters with the different prognostic factors showed statistically insignificant difference for age variable [above and below 40 years], gender, tumour size [less or more than 4 cm diameter], presence or absence of cervical adenopathy, type of pathology and extent of surgical resection [lobectomy Vs. thyroidectomy in papillary carcinoma patients]. But there was a borderline statistical significance difference [p=0.07] for locoregional disease free survival for patients with or without capsular invasion. Also, there was a statistical significant difference [p=0.02] for distant metastases free survival and overall survival [p=0.02] for patients with or without vascular invasion. The estimated overall 5-year survival was 96.8% and it was 80% for patients with vascular invasion and 97.6% for paints without vascular invasion. The rate of local recurrence and distant metastases in correlation with the different risk factors showed only significance for capsular and vascular invasion. The prognostic impact of age, gender, cervical adenopathy, size of the nodule, pathological subtypes and extent of surgical resection needs a longer follow-up to clarify the exact significance of those factors; However, capsular and vascular invasion carried a worse prognosis on loco-regional, distant metastases and overall survival on short term follow-up, hence those patients should be treated aggressively. FNA should be one of the main diagnostic methods of malignancy, by which unnecessary surgery for benign conditions could be avoided. We have to expand our efforts to identify high-risk patients more accurately, thereby facilitating a more rational approach to treatment and till this time lobectomy for papillary carcinoma should be extremely restricted even for low risk patients to those in whom surgical morbidity is highly expected