Differentiated thyroid cancer survival, recurrence rates by disease stage and quality of life in the Northern Cancer Network
Simon Pearce, Professor of Endocrinology and Honorary Consultant Endocrinologist, Institute of Genetic Medicine, International Centre for Life, Newcastle upon Tyne and Chief Investigator Dr Petros Perros.
Preliminary Report 21 February 2018
The purpose of this study is to ascertain thyroid cancer 5 and 10-year disease specific survival and recurrence rates by cancer stage at diagnosis, to assess QOL of long-term survivors of thyroid cancer, and to ascertain whether reforms in the NHS and the introduction of national guidelines were associated with thyroid cancer outcomes, by exploring trends in 5-year survival and recurrence rates over the past 10 years.
Data from Public Health England Office for Data Release (PHEODR), which were requested on 10 March 2016, were received in December 2017. These included 420 patients who had a new diagnosis of thyroid cancer made between 1st January 2000- 31st December 2005 who were treated in the Newcastle upon Tyne Hospitals NHS Foundation Trust. The censor date for the purpose of establishing vital status was 31st December 2017. The data supplied by PHEODR were cross-checked with electronic patient records of the Newcastle upon Tyne Hospitals NHS Foundation Trust and with the Integrated Clinical Environment (ICE) platform which accesses laboratory and radiology results and reports from other hospitals in the region.
This report summarises progress thus far.
Data on 420 patients were received. The demographics are shown in Table 1. Overall 7-18 year survival was 86.2%. Data on tumour histology and vital status are shown in Table 2. Multifocal tumours were reported in 99 cases (23.6%). TNM staging data were very scantly in the files provided by PHEODR (only available for 58/420, 13% of cases). Review of hospital electronic records has so far yielded staging data for 196 (46.7%) of patients. The data on staging and overall survival are shown in Table 3. This work is ongoing and we estimate that we will be able to derive staging data for over 80% of the 420 patients.
We had estimated that retrieval of data from the Northern region would yield approximately 800 patients. We have so far looked at data derived from one of the two main centres in the Northern region that provides services for patients with thyroid cancer (Newcastle upon Tyne Hospitals NHS Foundation Trust) and were able to access 420 cases. We anticipate that extension of the study to the other main centre (James Cook University Hospital, Middlesbrough) will provide the expected number of 800 cases.
Preliminary data show an overall 7-18 year survival which is similar to national 10 year survival figures (86.2% vs 85%) , However, the North East has the highest age-adjusted mortality rates from all causes in the UK  and therefore cancer specific mortality is expected to be lower.
In the EUROCARE-4 study  5 year age-adjusted relative survival for thyroid cancer in England was recorded as 80.5%, which was lower than the EUROCARE-4 mean (83.2%) and much lower than the best figures (Slovenia, 93.3%). The EUROCARE-4 study used data censored in 2001-2002, ie approximately 5 years earlier than our study. However mortality from thyroid cancer in the UK has been stable over many years. We can therefore speculate that given that our sample yielded an overall survival at 7-18 years of 86.2% and given that the data are not adjusted for age and geographical background of overall mortality, they support our hypothesis that the EUROCARE-4 data may have overestimated mortality from thyroid cancer in the UK, most likely due to under-recording of small papillary thyroid cancers, which have the best prognosis.
Our plan is to derive staging data from electronic records for all of the the 420 patients and update the parameters we have already alluded to in this report. We will also expand to interrogate the database for the impact of age, gender and histological type on 5 and 10 year survival and recurrences. This data will be compared to published series. We are awaiting to receive further data from PHEODR on causes of death and this will help derive cancer specific mortality.
Once we have completed this phase, we will roll it out to the James Cook University Hospital, and we will apply to ethics for the questionnaire component of the study assessing quality of life.
We initially intended to start the data collection in March 2016 and complete data collection in March 2017. We are therefore behind approximately by two years. The delay has been unfortunate and imposed by the time it has taken for PHEODR to filter and supply the data. A series of security checks to safeguard confidentiality had to be adhered to, which contributed to the delay. Since receiving the data (December 2017) we have made good progress and we anticipate to have completed the study by March 2019.
3. Verdecchia A, Francisci S, Brenner H, Gatta G, Micheli A, Mangone L, Kunkler I; EUROCARE-4 Working Group. Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data. Lancet Oncol. 2007;8:784-96.
Final report to follow.
Doris Godfrey Research Award
Doris Godfrey was a children's nurse who suffered from hypothyroidism. The impact of the disease on herself and particularly her mother motivated her to arrange a legacy of £48,000 for the BTF. This generous legacy has been used to fund this Award and will fund the 2018 Award.