ABSTRACT
BACKGROUND: The tall cell subtype of papillary thyroid cancer (TCPTC) is the most common aggressive subtype and often treated aggressively. This approach may not be necessary in smaller tumours without adverse histological characteristics. METHODS: 97 patients with TCPTC defined as a height-to-width ratio of ≥3:1 and at least 30% tall cells were compared against 390 classical papillary thyroid carcinoma (CPTC) based on tumour size with recurrence free survival (RFS) as the primary outcome. RESULTS: TCPTC are more likely to present with adverse histological characteristics. In smaller tumours (<2 âcm), only central lymph node metastasis (HR7.16 p â= â0.03) and multifocality (HR10.11 p â= â0.026) increased recurrence risk. In larger tumours, TCPTC histology (HR3.78 p â= â0.002), lymphovascular invasion (HR3.02 p â= â0.014) and central lymph node metastasis (HR3.24 p â< â0.001) significantly increased recurrence risk. CONCLUSION: TCPTC tumours <2 âcm without central lymph node metastasis and multifocality are similar in risk of recurrence to classical PTC and could be managed with lobectomy.
Subject(s)
Neoplasm Recurrence, Local , Thyroid Cancer, Papillary , Thyroid Neoplasms , Humans , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Female , Male , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Middle Aged , Thyroid Cancer, Papillary/pathology , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/mortality , Adult , Thyroidectomy , Lymphatic Metastasis , Retrospective Studies , Aged , Carcinoma, Papillary/pathology , Carcinoma, Papillary/surgery , Tumor Burden , Risk Assessment , Risk FactorsABSTRACT
BACKGROUND: People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes. OBJECTIVES: This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment. METHODS: In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes. RESULTS: Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences. CONCLUSIONS: There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients. IMPLICATIONS FOR PRACTICE: Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.
