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Der Nuklearmediziner 2010; 33(4): 249-256
DOI: 10.1055/s-0030-1267165
Schilddrüsenkarzinom – neue Aspekte in Diagnostik und Therapie

© Georg Thieme Verlag KG Stuttgart · New York

Langfristige Prognose des differenzierten Schilddrüsenkarzinoms

Long-term Prognosis of Differentiated Thyroid CarcinomaB. Riemann1 , J. A. Krämer1 , O. Schober1
  • 1Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Münster
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Publication History

Publication Date:
16 December 2010 (online)

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Zusammenfassung

Das differenzierte Schilddrüsenkarzinom hat insgesamt eine ausgezeichnete Prognose. Das liegt neben der Biologie des Tumors vor allem an der erfolgreichen Diagnostik, der optimierten und standardisierten Therapie sowie der Nachsorge dieser Tumorentität. Die Kombination aus Operation, Radioiodtherapie und Levothyroxin-Medikation ist die Methode der Wahl und wird in nationalen und internationalen Leitlinien empfohlen. Durch diese Therapieschemata lassen sich Überlebensraten von 80–100% erreichen. Besondere Bedeutung kommt der Risikostratifizierung zu. Diese orientiert sich an der UCC/AJCC TNM-Klassifikation zur Ermittlung der lokalen Tumorausdehnung und Erfassung von Lymphknoten- oder Fernmetastasen. In der Literatur wird eine Reihe differenzierender Prognosescores beschrieben, bei denen zum Teil unterschiedliche Risikofaktoren Berücksichtigung finden. Das Alter der Patienten, Tumorgröße, extrathyreoidales Wachstum, Lymphknoten- und Fernmetastasen sind die am häufigsten genannten Parameter, die in diese Scores integriert werden. Prospektive Studien zur Langzeitprognose von Patienten mit differenzierten Schilddrüsenkarzinomen sind wegen der guten Prognose rar, da sie sowohl sehr lange Nachbeobachtungszeiten als auch große Patientenzahlen voraussetzen. Dies ist in der Regel nur durch Multicenter-Studien zu erreichen. Aber auch retrospektive Analysen großer Patientenkollektive können helfen, valide Risikofaktoren für das differenzierte Schilddrüsenkarzinom zu identifizieren.

Abstract

In general, differentiated thyroid carcinomas have an excellent prognosis. In addition to the biological behavior of this tumor entity this is based on optimized diagnostic procedures as well as a standardized therapeutic management and after-care. The combination of surgery, radioiodine ablation and levothyroxine medication is an effective therapeutic algorithm recommended by national and international guidelines. Thereby, survival rates of 80–100% can be achieved. In this respect, a correct risk-stratification is of particular importance which relies primarily on the UICC/AJCC TNM-classification to determine the local tumor extent and lymph node or distant metastasis. In the literature, several distinct prognostic scores have been defined accounting for different risk factors. Patient age at diagnosis, tumor size, extrathyroidal growth, lymph node and distant metastases are the most commonly used parameters integrated into these scores. Prospective studies on the long-term prognosis of patients with differentiated thyroid carcinomas are rare because of the favourable prognosis requiring long-term follow-up times and large patients cohorts. In general, this can only be achieved by multicentre studies. Retrospective analyses of large patient populations, however, can help to identify reliable risk factors of patients with differentiated thyroid carcinomas.

Schlüsselwörter

Prognose - Schilddrüsenkarzinom - individualisierte Medizin

Key words

prognosis - thyroid cancer - individualized medicine

Literatur

  • 1 Ain KB. Anaplastic thyroid carcinoma: behavior, biology and therapeutic approaches.  Thyroid. 1998;  8 715-726
    CrossrefPubMedGoogle Scholar
  • 2 Akslen LA. Prognostic importance of histologic grading in papillary thyroid carcinoma.  Cancer. 1993;  72 2680-2685
    CrossrefPubMedGoogle Scholar
  • 3 Beenken S, Roye D, Weiss H. et al . Extent of surgery for intermediate-risk well-differentiated thyroid cancer.  Am J Surg. 2000;  179 51-56
    PubMedGoogle Scholar
  • 4 Biermann M, Pixberg M, Riemann B. et al . Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer.  Nuklearmedizin. 2009;  48 89-98
    PubMedGoogle Scholar
  • 5 Byar DP, Green SB, Dor P. et al . A prognostic index for thyroid carcinoma. A study of the EORTC Thyroid Cancer Cooperative Group.  Eur J Cancer. 1979;  15 1033-1041
    PubMedGoogle Scholar
  • 6 Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma.  Surgery. 1988;  104 947-953
    PubMedGoogle Scholar
  • 7 Cooper DS, Doherty GM, Haugen BR. et al . Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.  Thyroid. 2009;  19 1167-1214
    Google Scholar
  • 8 DeGroot LJ, Kaplan EL, McCormick M. et al . Natural history, treatment, and course of papillary thyroid carcinoma.  J Clin Endocrinol Metab. 1990;  71 414-424
    CrossrefPubMedGoogle Scholar
  • 9 DeLellis RA, Lloyd RV, Heitz PU. et al .World Health Organisation Classification of Tumours. Pathology and Genetics of Tumours of Endocrine organs.. Lyon; IARC Press; 2004
    Google Scholar
  • 10 Dietlein M, Dressler J, Eschner W. et al . Guideline for 131I whole-body scintigraphy for differentiated thyroid cancer (version 3).  Nuklearmedizin. 2007;  46 206-212
    PubMedGoogle Scholar
  • 11 Dietlein M, Dressler J, Eschner W. et al . Procedure guidelines for radiodine therapy of differentiated thyroid cancer (version 3).  Nuklearmedizin. 2007;  46 213-219
    PubMedGoogle Scholar
  • 12 Dietlein M, Luster M, Reiners C. Differenziertes Schilddrüsenkarzinom: risikoadaptierte Behandlung und Nachsorge, Thieme-Refresher Onkologie. Stuttgart; 2008: R1-R24
    Google Scholar
  • 13 Dralle H. Maligne Schilddrüsentumoren. Für die Deutsche Krebsgesellschaft. Kurzgefasste interdisziplinäre Leitlinien 2006. Empfehlungen zur Diagnostik und Therapie maligner Erkrankungen. München: W. Zuckerschwerdt; 2006: 53-61
    Google Scholar
  • 14 Franceschi S, Boyle P, Maisonneuve P. et al . The epidemiology of thyroid carcinoma.  Crit Rev Onco. 1993;  4 25-52
    PubMedGoogle Scholar
  • 15 Franzius C, Dietlein M, Biermann M. et al . Procedure guideline for radioiodine therapy and 131iodine whole-body scintigraphy in paediatric patients with differentiated thyroid cancer.  Nuklearmedizin. 2007;  46 224-231
    PubMedGoogle Scholar
  • 16 Gilliland FD, Hunt WC, Morris DM. et al . Prognostic factors for thyroid carcinoma: a population-based study of 15 698 cases for the Surveillance, Epidemiology and End Results (SEER) program 1973–1991.  Cancer. 1997;  79 564-573
    CrossrefPubMedGoogle Scholar
  • 17 Gospodarowicz MK, Miller D, Groome PA. et al . The process for continuous improvement of the TNM classification.  Cancer. 2004;  100 1-5
    CrossrefPubMedGoogle Scholar
  • 18 Hay ID, Grant CS, Taylor WF. et al . Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system.  Surgery. 1987;  102 1088-1095
    PubMedGoogle Scholar
  • 19 Hay ID, Bergstralh EJ, Goellner JR. et al . Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989.  Surgery. 1993;  114 1050-1057
    PubMedGoogle Scholar
  • 20 Henderson YC, Ahn SH, Clayman GL. Inhibition of the growth of papillary thyroid carcinoma cells by CI-1040.  Arch Otolaryngol Head Neck Surg. 2009;  135 347-354
    CrossrefPubMedGoogle Scholar
  • 21 Hung W, Sarlis NJ. Current controversies in the management of pediatric patients with well-differentiated nonmedullary thyroid cancer: a review.  Thyroid. 2002;  12 683-702
    CrossrefPubMedGoogle Scholar
  • 22 Ito Y, Miyauchi A, Jikuzono T. et al . Risk factors contributing to a poor prognosis of papillary thyroid carcinoma: validity of UICC/AJCC TNM classification and stage grouping.  World J Surg. 2007;  31 838-848
    CrossrefPubMedGoogle Scholar
  • 23 Krämer JA, Schmid KW, Dralle H. et al . Primary tumour size is a prognostic parameter in patients suffering from differentiated thyroid carcinoma with extrathyroidal growth: results of the MSDS trial.  Eur J Endocrinol. 2010;  Epub ahead of print
    PubMedGoogle Scholar
  • 24 Lerch H, Schober O, Kuwert T. et al . Survival of differentiated thyroid carcinoma studied in 500 patients.  J Clin Oncol. 1997;  15 2067-2075
    PubMedGoogle Scholar
  • 25 Lin JC, Kuo WR, Chiang FY. et al . Glutathione peroxidase 3 gene polymorphisms and risk of differentiated thyroid cancer.  Surgery. 2009;  145 508-513
    CrossrefPubMedGoogle Scholar
  • 26 Luster M, Clarke SE, Dietlein M. et al . Guidelines for radioiodine therapy of differentiated thyroid cancer.  Eur J Nucl Med Mol Imaging. 2008;  35 1941-1959
    CrossrefPubMedGoogle Scholar
  • 27 Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. A comparative analysis.  Cancer. 2005;  103 2269-2273
    CrossrefPubMedGoogle Scholar
  • 28 Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.  Am J Med. 1994;  97 418-428
    CrossrefPubMedGoogle Scholar
  • 29 Mazzaferri EL. Long-term outcome of patients with differentiated thyroid carcinoma: effect of therapy.  Endocr Pract. 2000;  6 469-476
    PubMedGoogle Scholar
  • 30 Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer.  J Clin Endocrinol Metab. 2001;  86 1447-1463
    CrossrefPubMedGoogle Scholar
  • 31 Nucera C, Eeckhoute J, Finn S. et al . FOXA1 is a potential oncogene in anaplastic thyroid carcinoma.  Clin Cancer Res. 2009;  15 3680-3689
    CrossrefPubMedGoogle Scholar
  • 32 Pacini F, Schlumberger M, Dralle H. et al . European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium.  Eur J Endocrinol. 2006;  154 787-803
    CrossrefPubMedGoogle Scholar
  • 33 Pasieka JL, Zedenius J, Auer G. et al . Addition of nuclear, DNA content to the, AMES risk-group classification for papillary thyroid cancer.  Surgery. 1992;  112 1154-1159
    PubMedGoogle Scholar
  • 34 Pufnock JS, Rothstein JL. Oncoprotein signaling mediates tumor-specific inflammation and enhances tumor progression.  J Immunol. 2009;  182 5498-5506
    CrossrefPubMedGoogle Scholar
  • 35 Rahbar K, Hutzenlaub V, Fischer RJ. et al . Risk-profile and outcome of small papillary and follicular thyroid carcinomas.  Nuklearmedizin. 2008;  47 188-194
    PubMedGoogle Scholar
  • 36 Ricarte-Filho JC, Ryder M, Chitale DA. et al . Mutational profile of advanced primary and metastatic radioactive iodine-refractory thyroid cancers reveals distinct pathogenetic roles for BRAF, PIK3CA, and AKT1.  Cancer Res. 2009;  69 4885-4893
    CrossrefPubMedGoogle Scholar
  • 37 Riemann B, Schober O. Are “high-risk” patients with differentiated thyroid cancer “healthy patients”?.  Nuklearmedizin. 2008;  47 179-180
    PubMedGoogle Scholar
  • 38 Riemann B, Schober O. Therapeutic strategy of papillary microcarcinoma of the thyroid gland: a nuclear medicine perspective.  Minerva Endocrinol. 2009;  34 81-87
    PubMedGoogle Scholar
  • 39 Robbins RJ, Wan Q, Grewal RK. et al . Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography scanning.  J Clin Endocrinol Metab. 2006;  91 498-505
    CrossrefPubMedGoogle Scholar
  • 40 Schlumberger M. Papillary and follicular thyroid carcinoma.  New Engl J Med. 1998;  338 297-306
    CrossrefPubMedGoogle Scholar
  • 41 Schmid KW, Wittekind C. Die missglückte Klassifikation.  Pathologe. 2003;  24 338
    CrossrefPubMedGoogle Scholar
  • 42 Shaha AR, Loree TR, Shah JP. Intermediate-risk group for differentiated carcinoma of thyroid.  Surgery. 1994;  116 1036-1040
    PubMedGoogle Scholar
  • 43 Noguchi S, Murakami N, Kawamoto H. Classification of papillary cancer of the thyroid based on prognosis.  World J Surg. 1994;  18 552-557
    CrossrefPubMedGoogle Scholar
  • 44 Sherman SI, Brierley JD, Sperling M. et al . Prospective multicenter study of thyroid carcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group.  Cancer. 1998;  83 1012-1021
    CrossrefPubMedGoogle Scholar
  • 45 Sobin LH, Wittekind Ch. UICC TNM Classification of Malignant Tumors. 5th Edition, Wiley-Liss, New York; 1997
    Google Scholar
  • 46 Sobin LH, Wittekind Ch. UICC TNM Classification of Malignant Tumors. 6th Edition, Wiley-Liss, New York; 2002
    Google Scholar
  • 47 Sobin LH, Gospodarowicz MK, Wittekind Ch. UICC TNM Classification of Malignant Tumors. 7th Edition, Wiley-Liss, New York; 2009
    Google Scholar
  • 48 Verburg FA, Mäder U, Luster M. et al . Histology does not influence prognosis in differentiated thyroid carcinoma when accounting for age, tumour diameter, invasive growth and metastases.  Eur J Endocrinol. 2009;  160 619-624
    CrossrefPubMedGoogle Scholar
  • 49 Verburg FA, Mäder U, Luster M. et al . Primary tumour diameter as a risk factor for advanced disease features of differentiated thyroid carcinoma.  Clin Endocrinol. 2009;  71 291-297
    CrossrefPubMedGoogle Scholar
  • 50 Verburg FA, Mäder U, Kruitwagen CL. et al . A comparison of prognostic classification systems for differentiated thyroid carcinoma.  Clin Endocrinol. 2010;  72 830-838
    PubMedGoogle Scholar
  • 51 Verburg FA, Stokkel MP, Düren C. et al . No survival difference after successful 131I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer.  Eur J Nucl Med Mol Imaging. 2010;  37 276-283
    CrossrefPubMedGoogle Scholar
  • 52 Volante M, Landolfi S, Chiusa L. et al . Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients.  Cancer. 2004;  100 950-957
    CrossrefPubMedGoogle Scholar
  • 53 Wittekind C, Greene FL, Henson DE. et al .TNM Supplement.. 3rd Edition, Wiley-Liss, New York; 2003
    CrossrefGoogle Scholar
  • 54 Wong JB, Kaplan MM, Meyer KB. et al . Ablative radioactive iodine therapy for apparently localized thyroid carcinoma. A decision analytic perspective.  Endocrinol Metab Clin North Am. 1990;  19 741-760
    PubMedGoogle Scholar

Korrespondenzadresse

Prof. Dr. Burkhard Riemann

Klinik und Poliklinik für

Nuklearmedizin

Universitätsklinikum Münster

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48149 Münster

Phone: +49/251/834 7365

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