[Operation strategy for follicular thyroid carcinoma].

BACKGROUND & OBJECTIVE: The operation strategies for follicular thyroid carcinoma (FTC), a kind of differentiated thyroid carcinoma, are controversial. This study was to summarize the prognosis of FTC patients after operation, and explore the optimal operation pattern.

METHODS: Clinical data of 176 FTC patients who underwent operation at Cancer Hospital of Tianjin Medical University from Jan. 1956 to Dec. 2004 were analyzed. Of the 176 patients, 21 underwent total thyroidectomy, 155 underwent partial thyroidectomy.

RESULTS: The overall 5-, 10-, and 15-year survival rates were 88.9%, 82.4%, and 79.0%. Lymph node metastasis, distant metastasis and pathologic type (widely invasive follicular carcinoma, WIFTC/minimally invasive follicular carcinoma, MIFTC) had significant influences on the prognosis (P<0.01). The 5-, 10-, and 15-year survival rates were 85.7%, 80.9%, and 80.9% in total thyroidectomy group and 89.0%, 83.2%, and 78.1% in partial thyroidectomy group (P>0.05). The 5-, 10-, and 15-year recurrence rates were significantly higher in total thyroidectomy group than in partial thyroidectomy group (0 vs. 3.2%, 4.8% vs. 6.4%, 4.8% vs. 7.7%, P<0.05). The overall lymph node metastasis rate was 11.9%. The occult metastasis rate in 21 stage cN0 patients was 19.0%. Among 21 cases of lymph node metastasis, 16 (76.2%) were located in region VI. The lymph node metastasis rate was significantly higher in WIFTC group than in MIFTC group (21.1% vs. 5.7%, P<0.01).

CONCLUSIONS: We suggest total thyroidectomy for the patients with WIFTC or distant metastasis, and unilateral lobectomy and isthmectomy for the patients with MIFTC. Neck dissection is not necessary for stage cN0 patients, but routine follow-up is necessary for WIFTC patients.