What is the prognosis of follicular thyroid carcinoma (FTC)?

Updated: Jun 18, 2020
  • Author: Luigi Santacroce, MD; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

In contrast to other cancers, thyroid cancer is almost always curable. In fact, most FTCs are slow growing and are associated with a very favorable prognosis. Mean mortality rates are 1.5% in females and 1.4% in males.  FTC prognosis is related to age, sex, and staging. In general, if the cancer does not extend beyond the capsule of the gland, life expectancy is minimally affected. Prognosis is better in female patients and in patients younger than 40 years. The 5-year relative survival rate for 2010-2016 was 98.3%. [12]

Current World Health Organization classification proposes three subtypes of FTC: minimally invasive, encapsulated angioinvasive, and widely invasive. [13] O'Neill et al reported that disease‐free survival rates at 40 months in patients with those three subtypes were 97%, 81%, and 46%, respectively. [14]

Mean survival rate after 10 years is 60%. Metastases are still rare and are due to angioinvasion and hematogenous spread. Lymphatic involvement is even more rare, occurring in less than 10% of cases. In some patients, however, metastases are found at diagnosis.

In a Spanish study of FTC in 66 patients, with follow-up of 99 ± 38 months, disease-related mortality was 3%; disease-free survival rates were 71% at 5 years and 58% at 10 years. The main predictive factors for recurrence were the presence of local clinical symptoms and infiltration into neighboring structures. [15]

A relatively large prospective study by Sugino et al demonstrates that age and primary tumor size may result in poorer outcome for patients with distant metastases. Authors recommend conservative management for younger patients with minimally invasive follicular thyroid carcinoma with small tumors. [16]

Unlike medullary thyroid carcinoma, FTC is not part of a multiple endocrine neoplasia (MEN) syndrome.


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