[Prognostic criteria of papillary thyroid cancer. Morphologic clinical analysis of 202 cases of tumor].

A retrospective study of 202 papillary thyroid carcinomas was conducted to determine the prognostic value of different morphological and clinical features. The biological behaviour was primarily influenced by tumor type: Among encapsulated (n = 28) and occult lesions (n = 34), each time recurrence-free survival was seen, whereas 22% of patients with widely invasive tumours (n = 140) died from carcinoma (mean observation period: 9.6 years). In the latter group, dismal prognosis was demonstrated for older patients (greater than 52 years) and oxyphilic or poorly differentiated tumours; the same effect was shown for presence of distant haematogenous spread and tumour invasion of cervical soft tissue. Since lethal outcome was seen even in cases lacking the aforenamed unfavourable criteria, total thyroidectomy should be performed for all widely invasive neoplasms regardless of cellular or histological differentiation, stage of disease and age at diagnosis. The same applies for the two prognostically excellent subtypes in the case of regional metastases. As opposed to this, hemithyroidectomy and life-long TSH-suppressive oral hormone replacement therapy is regarded to be sufficient in encapsulated and occult papillary tumours not accompanied by regional or distant metastases.