Keywords:
follicular thyroid carcinoma, prevalence, subtypes, outcomes, management, thyroidectomy, South Africa
Abstract
Background: Follicular thyroid carcinoma (FTC) accounts for approximately 17–20% of well-differentiated thyroid cancer (WDTC) worldwide. In South Africa (SA), FTC is more common than reported internationally, however, available SA studies included small patient numbers. This multi-institutional study comprehensively describes FTC patients who underwent surgery over a 5-year period, focusing on presentation, diagnosis, and management.
Methods: A retrospective review of all patients with FTC operated at 13 academic hospitals throughout SA between January 2015 and December 2019 was conducted. The Thyroid Cancer Group of South Africa collectively entered data on the presentation, diagnosis, management, and short-term outcomes of 464 thyroid cancer patients into a REDCap database. Descriptive statistical analysis was performed.
Results: Of 464 cases captured in the database, 103 (22.1%) were FTCs. WDTC was reported in 87.9% (408/464) of operations, with FTC comprising 25.2% (103/408). Of the 103 FTC patients, 82.5% (n = 85) were female and 16.5% (n = 17) male. The mean age was 51.8 years (SD 17.3). In cases where staging was reported, more than half (53.9%) presented with T3 tumours. Distant metastases were found in 12.6% of patients. Thyroid lobectomy was the most performed procedure (57.4%), followed by total thyroidectomy (37.6%).
Conclusions: SA presents a multifaceted picture of FTC, with a higher incidence than in developed countries but lower than some other African nations. Patients are frequently symptomatic, which may predict worse outcomes. Standardised reporting and a national thyroid registry could assist in treatment planning and consistency of care.
Author Biographies
Z Pienaar, Stellenbosch University
Division of Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa
L Martin, Stellenbosch University
Division of Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa
T Luvhengo, University of the Witwatersrand
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
JA Lübbe, Stellenbosch University
Division of Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa
A Bestbier, Port Elizabeth Hospital Complex
Department of Surgery, Port Elizabeth Hospital Complex, South Africa
M Bhuiyan, University of Limpopo
Department of General Surgery, Faculty of Health Science, Mankweng Academic Hospital, University of Limpopo, South Africa
I Bombil, University of the Witwatersrand
Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, South Africa
SR Čačala, Stellenbosch University
Division of Surgery, Tygerberg Hospital, Stellenbosch University, South Africa
L Cairncross, University of Cape Town
Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
C Changfoot, Stellenbosch University
Division of Surgery, Tygerberg Hospital, Stellenbosch University, South Africa
BS Jackson, University of Pretoria
Department of Surgery, Kalafong Provincial Tertiary Hospital, University of Pretoria, South Africa
HS Jehle, Life St. George’s Hospital
Life St. George’s Hospital, Port Elizabeth, South Africa
L Jonas, University of Limpopo
Department of General Surgery, Polokwane Provincial Hospital, University of Limpopo, South Africa
MR Lukusa, University of KwaZulu-Natal
Department of Surgery, Grey’s Hospital, University of KwaZulu-Natal, South Africa
M Makgoka, University of Pretoria
Department of Surgery, Steve Biko Academic Hospital, University of Pretoria, South Africa
A Yeo, University of the Witwatersrand
Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, South Africa
NT Sishuba, University of the Witwatersrand
Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa
R Razack, Stellenbosch University
Division of Anatomical Pathology, Department of Pathology, Stellenbosch University, South Africa
National Health Laboratory Service, Tygerberg Hospital, South Africa
K Baatjes, Stellenbosch University
Division of Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa
W Conradie, Stellenbosch University
Division of Surgery, Department of Surgical Sciences, Stellenbosch University, South Africa
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