Prognosis of Papillary Thyroid Cancer
Year: 2005
Type: dissertation
Study design: Observational Study
Abstract: 7 Age over 45 years, tumour size > 4 cm, extrathyroidal extension of tumour, nodal metastases, distant metastases, and stage IV disease signifi cantly correlated with survival. Expression of COX-2, Ki-67, and VEGF-C was higher in older patients, and expression of these markers correlated with stage, but not with other clinical parameters or aggressive disease. Among the patients with positive lymph nodes, most tumours of older patients expressed VEGF-C, but most of those younger patients did not. Immunohistochemically, expression of COX-2 and VEGF-C correlated strongly with each other. In cell culture studies, both VEGF-C and COX-2 were induced by phorbol 12-myristate 13-acetate (PMA), but the selective COX-2 inhibitor N-(2-Cyclohexyloxy-4-nitrophenyl)-Methanesulfonamide (NS398) did not reduce VEGF-C expression. Thus, correlation of COX-2 and VEGFC was not so clear. Stromal expression of MMP-2 correlated with the extent of the primary tumour and with advanced stage, but not with aggressive disease. Expression of p21 was higher in tumours extending beyond the thyroid capsule and in larger tumours, but expression did not correlate with aggressive disease. Expression of Bcl-2 correlated neither with clinical parameters nor aggressive disease. Most patients with papillary thyroid cancer can be cured if treated according to best clinical practice. In older patients, PTC is a more aggressive disease. Lymph node metastases (LNM) seemed to be predictive for distant metastases and death in older patients, but not at all for those younger. Unexpectedly, however, some young low-risk patients do suffer from aggressive disease. How to recognize these young patients is the problem. Although we found elevated expression of COX-2, VEGF-C, and Ki-67 in those older, these three markers did not predict patient outcome. Better understanding of differences in tumour biology in young and older patients may help us to select those young patients who display the tumour behaviour of older patients. Initial treatment and follow-up could be individualized according to age. Older lymph node-positive PTC patients may benefi t from more radical lymph node dissection. These patients may also benefi t from COX-2 selective inhibitors.
Source: Työväentutkimus Vuosikirja
Author: Päivi Siironen
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2120136404