RESUMEN
BACKGROUND: The incidence of papillary thyroid microcarcinoma (PTMC) is increasing. OBJECTIVE: To analyze the long-term prognosis of PTMC. METHOD: Study population: patients with a histopathological diagnosis of PTMC (size ≤ 1 cm) treated according to the risk of recurrence of the Latin American Thyroid Society. Inclusion criteria: minimum follow-up of 2 years, availability of histopathological samples, and treatment compliance. Exclusion criteria: previous thyroid surgery, other synchronous malignancies or ectopic location of the PTMC. Study variables: persistences, recurrences and mortality. RESULTS: Based on the risk of recurrence, PTMC has very low risk in 65.2% (n = 105), low risk in 17.4% (n = 28) and high risk in 17.4% (n = 28). In high risk patients, total thyroidectomy was performed in all cases, cervical lymphadenectomy in 57,1% (n = 16) and metabolic therapy with I131 in all cases. During a mean follow-up of 119,8 ± 65 months, 0.6% (n = 1) of recurrences took place. Risk factors associated to recurrence were not identified. No patient died due to MCPT. CONCLUSIONS: PTMC treated based on its risk of recurrence has a good long-term prognosis, without persistences, with a low number of recurrences and absence of disease-associated mortality.
ANTECEDENTES: La incidencia del microcarcinoma papilar de tiroides (MCPT) está aumentado. OBJETIVO: Analizar el pronóstico a largo plazo del MCPT. MÉTODO: Población a estudio: pacientes con diagnóstico histopatológico de MCPT (tamaño ≤ 1 cm) tratados según el riesgo de recurrencia de la Sociedad Latinoamericana de Tiroides. Criterios de inclusión: seguimiento mínimo de 2 años, disponibilidad de las muestras histopatológicas y cumplimiento del tratamiento. Criterios de exclusión: cirugía tiroidea previa, otras patologías malignas sincrónicas o localización ectópica del MCPT. Variables a estudio: persistencias, recidivas y mortalidad. RESULTADOS: Según el riesgo de recurrencia, el 65.2% (n = 105) tuvo muy bajo riesgo, el 17.4% (n = 28) bajo riesgo y el 17,4% (n = 28) alto riesgo. En los pacientes de alto riesgo se realizó tiroidectomía total en todos los casos, linfadenectomía cervical en el 57,1% (n = 16) y terapia metabólica con I131 en todos los casos. Durante un seguimiento medio de 119,8 ± 65 meses hubo un 0,6% (n = 1) de recurrencias. No se evidenciaron factores de riesgo asociados a recidiva de la enfermedad. Ningún paciente falleció debido al MCPT. CONCLUSIONES: El MCPT tratado en función del riesgo de recurrencia tiene un buen pronóstico a largo plazo, sin persistencias, con una baja cifra de recurrencias y ausencia de mortalidad debida a la enfermedad.
Asunto(s)
Carcinoma Papilar , Neoplasias de la Tiroides , Carcinoma Papilar/epidemiología , Carcinoma Papilar/cirugía , Humanos , Recurrencia , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
BACKGROUND: Genetic study of the RET proto-oncogene has modified the management, treatment, and prognosis of medullary thyroid carcinoma (MTC), multiple endocrine neoplasia 2A (MEN 2A), for patients with less advanced tumor stages. Classically, the diagnosis was based on an increase in basal and poststimulus peak calcitonin (bCT and pCT). Prophylactic thyroidectomy, based on results of genetic testing, may reduce recurrences in MTC. STUDY DESIGN: Of 82 MTC (MEN 2A) patients genetically diagnosed and surgically treated at our center, 22 received a prophylactic thyroidectomy (RET +, bCT and pCT with normal values and asymptomatic). We analyzed age, gender, phenotype, RET mutation, cervical ultrasound, laboratory tests (bCT, pCT, and CEA), surgery, histologic data, TNM, and followup. RESULTS: The 22 patients belonged to 8 families with MTC (MEN 2A). Mean age was 15.2 years (range 5 to 36 years). The RET mutation in 21 patients was Cys-->Tyr and in the remaining patient both in codon 634 in exon 11. The median values of bCT and pCT were 38 pg/mL (range < 15 to 75 pg/mL) and 148.5 pg/mL (range < 15 to 250 pg/mL), respectively. Total thyroidectomy was performed in 8 patients (age < or = 10 years) and associated central neck dissection in 14 patients (age> 10 years). Histologic study showed 7 C-cell hyperplasias and 15 MTCs (8 bilateral); the median size was 0.2 cm (range < 0.1 to 0.7cm); 1 patient had metastatic adenopathies. According to TNM, 7 were stage 0, 14 were stage I, and 1 was stage III. Postsurgery bCT and pCT values were normal in all patients, with a curative rate of 100%. MTC patients compared with C-cell hyperplasia patients were older on average, had higher mean bCT, mean pCT, and mean CEA. CONCLUSIONS: Prophylactic thyroidectomy based on genetic testing allows identification and treatment of patients at an early stage of the disease and decreases recurrence rates. pCT values above the upper limit of normal may be markers for the presence of MTC and should be considered in selecting operative procedures for these patients.