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Kim, Hur, Kim, Lee, Kim, Oh, Choe, Lee, Kim, Nam, Yang, and Kim: Prognostic Factors and Treatment in Follicular Thyroid Carcinoma
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 78(3): 149-156.

Published online: 31 March 2010

DOI: https://doi.org/10.4174/jkss.2010.78.3.149

Prognostic Factors and Treatment in Follicular Thyroid Carcinoma

Wan Wook Kim, M.D.2, Sung Mo Hur, M.D., Sung Hoon Kim, M.D., Se Kyung Lee, M.D., Sangmin Kim, M.D., Young Lyun Oh, M.D.1, Jun-Ho Choe, M.D., Jeong Eon Lee, M.D., Jung-Han Kim, M.D., Seok Jin Nam, M.D., Jung-Hyun Yang, M.D., Jee Soo Kim, M.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

1Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

2Department of Surgery, College of Medicine, Kyungpook National University, Daegu, Korea.

Corresponding author (js0507.kim@samsung.com)

Received 21 October 2009       Accepted 18 December 2009

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) are two main subtypes of well-differentiated thyroid cancer. Sometimes FTCs present more aggressive features such as vascular invasion. The object of this study was to investigate the clinicopathologic features, prognostic factors and treatment outcome of FTC.

Methods

This retrospective study enrolled 91 patients diagnosed with FTC between November 1994 and October 2008. The clinicopathologic characteristics, treatment outcome and follow up data were analyzed.

Results

The median follow-up (f/u) period was 76.1 months. Distant metastases at the time of diagnosis were detected in 12 patients. During the f/u period, one local recurrence and 4 distant metastases developed. Local recurrence or distant metastasis were noticed in 12 out of 19 patients with widely invasive type and 5 out of 36 patients with minimally invasive type with vascular invasion were also noted. The median times to local recurrence or distant metastasis were 59.0 and 34.2 months, respectively. On analysis, according to the clinocopathologic factors, presence of vascular invasion, extrathyroidal extension, invasion to structure, incomplete excision and pathological classification were independent prognostic factors for recurrence or distant metastasis. Disease specific mortality was seen in one patient.

Conclusion

This study shows that aggressive treatments such as total thyroidectomy followed by radioiodine therapy and close follow-up of patients with minimally invasive type with vascular invasion and widely invasive type of FTC should be considered due to the chance of local recurrence and distant metastasis.

Keywords: Follicular thyroid carcinoma, Prognostic factor, Treatment

Figures and Tables

Fig. 1
Disease free survival curve for patients with FTC (follicular thyroid carcinoma) according to pathological classification. Event = local recurrence or distant metastasis, Group 1 = minimally invasive FTC without vascular invasion, Group 2 = minimally invasive FTC with vascular invasion, Group 3 = widely invasive FTC, P<0.001.
jkss-78-149-g001
Table 1
Demographic finding of FTC according to pathological classification
jkss-78-149-i001

*Group 1 = minimally invasive FTC (follicular thyroid carcinoma) without vascular invasion; †Group 2 = minimally invasive FTC with vascular invasion; ‡Group 3 = widely invasive FTC; §FNA = fine needle aspiration cytology; ∥FN = follicular neoplasm; PTC = papillary thyroid carcinoma; **Miscellaneous = nodular hyperplasia, adenomatous goiter, follicular adenoma, hurthle cell tumor.

Table 2
Characteristics of FTC according to pathological classification
jkss-78-149-i002

*Group 1 = minimally invasive FTC (follicular thyroid carcinoma) without vascular invasion; †Group 2 = minimally invasive FTC with vascular invasion; ‡Group 3 = widely invasive FTC; §Completion = completion total thyroidectomy; ∥RI = radioactive iodine ablation.

Table 3
Clinical outcome of FTC according to pathological classification
jkss-78-149-i003

*Group 1 = minimally invasive FTC (follicular thyroid carcinoma) without vascular invasion; †Group 2 = minimally invasive FTC with vascular invasion; ‡Group 3 = widely invasive FTC; §One of 9 was dead due to multiple metastasis.

Table 4
Independent prognostic factors assessed by Cox's regression analysis for recurrence or metastasis
jkss-78-149-i004

*Group category is analyzed by Log rank test because it is not available to be analyzed by multivariate Cox's regression test; †Group 1 = minimally invasive FTC without vascular invasion; ‡Group 2 = minimally invasive FTC with vascular invasion; §Group 3 = widely invasive FTC.

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