Did the 8th edition of TNM classification bring any significant changes in the complex treatment of patients with differentiated thyroid cancer? Discussion with the President of IFHNOS

Materials and methods.

From 1973 to 2015, 29 325 patients with various thyroid diseases were operated in different clinics of our department, 4353 (14.8%) of them had thyroid cancer. A 42-year period of work revealed significant changes in surgical tactics. We divided all the patients into 3 groups: 1st group (1 period) – from 1973 to 1988, 604 patients; 2nd group (2 period) – from 1989 to 1997, 652 patients operated; 3rd group (3 period) – from 1998 to 2015, with 3097 patients operated.

From 1973 to 1988, organ sparing surgeries were applied for papillary, follicular and sporadic medullary carcinomas T1, T2, and T3. The revision of the III-VI groups of cervical lymph nodes, their biopsy, central lymphadenectomy (CLAE), lateral lymphadenectomy (LLAE) were also performed. Since 1989, the number of thyroidectomies has doubled (53.0 versus 26.2%) due to the ability to control the dissemination and recurrence of thyroid cancer by the level of stimulated thyroglobulin and TSH (thyroid-stimulating hormone), suppressive treatment with thyroxine. Since 1998, the operation on the thyroid in each patient was supplemented by CLAE under visual control, as well as by intraoperative monitoring of the recurrent laryngeal nerve (since 2000) and parathyroid glands.

Results. The therapeutic and prophylactic CLAE led to metastases detection in 33.9% among 3069 patients with thyroid cancer. LLAE revealed additional cancer focuses in 60-80% of cases. The number of the CLAE within the last 10 years has been increased up to 89.9%. Thyroidectomy with CLAE reduced the number of patients with laryngeal muscles paresis from 1.6 to 0.26% after 1998. Also, since 1998 the distant relapse rate decreased from 0.5 to 0.27%, which was significantly (p> 0.05) less than after surgeries with no CLAE (1.4%). 1102 of 1298 patients who underwent surgery since 1989 were followed up for 10 years and more. Five, ten, and twenty years of observation showed that regional recurrences within the zones of negative biopsy (III–VI levels of lymph nodes) occurred only in 1.5% of cases. Thus, improving the surgical tactics and techniques in patients with differentiated thyroid cancer ensured the improvement of immediate and long-term results. The 40-year results of thyroid cancer patients’ treatment demonstrated an improvement in immediate and longterm results. Discussion with the co-author of the 8th edition of TNM classification returns us to those canons that we used in the 1980-90s, but mostly abandoned due to a number of relevant reasons.

Key words: thyroid cancer, TNM classification.

Authors declare no conflict of interests for this article.

Source of financing. Unspecified.

For citations: Romanchishen A.F., Vabalaite K.V., Romanchishen F.A., Tymkiv E.A. Did the 8th edition of TNM classification bring any significant changes in the complex treatment of patients with differentiated thyroid cancer? Discussion with the President of IFHNOS. Golova I Sheya Head and neck Russian Journal. 2018;6(2):63–68 (in Russian).

The authors are responsible for the originality of the presented data and the possibility of publishing illustrative material – tables, drawings, photographs of patients.