scholarly journals Prognostic Factors for Persistent or Recurrent Disease of Papillary Thyroid Carcinoma with Neck Lymph Node Metastases and/or Tumor Extension beyond the Thyroid Capsule at Initial Diagnosis

2005 ◽  
Vol 90 (10) ◽  
pp. 5723-5729 ◽  
Author(s):  
Sophie Leboulleux ◽  
Carole Rubino ◽  
Eric Baudin ◽  
Bernard Caillou ◽  
Dana M. Hartl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Recurrent Disease ◽  
Significant Risk ◽  
Papillary Thyroid ◽  
Tumor Extension ◽  
Persistent Disease ◽  
Thyroglobulin Level ◽  
Thyroid Capsule

Context: Reliable prognostic factors are needed in papillary thyroid cancer patients to adapt initial therapy and follow-up schemes to the risks of persistent and recurrent disease. Objective and Settings: To evaluate the respective prognostic impact of the extent of lymph node (LN) involvement and tumor extension beyond the thyroid capsule, we studied a group of 148 consecutive papillary thyroid cancer patients with LN metastases and/or extrathyroidal tumor extension. Initial treatment, performed at the Institut Gustave Roussy between 1987 and 1997, included in all patients a total thyroidectomy with central and ipsilateral en bloc neck dissection followed by radioactive iodine ablation. Results: Uptake outside the thyroid bed, demonstrating persistent disease, was found on the postablation total body scan (TBS) in 22% of the patients. With a mean follow-up of 8 yr, eight patients (7%) with a normal postablation TBS experienced a recurrence. Ten-year disease-specific survival rate was 99% (confidence interval, 97–100%). Significant risk factors for persistent disease included the numbers of LN metastases (>10) and LN metastases with extracapsular extension (ECE-LN >3), tumor size (>4 cm), and LN metastases location (central). Significant risk factors for recurrent disease included the numbers of LN metastases (>10), ECE-LN (>3), and thyroglobulin level measured 6–12 months after initial treatment after T4 withdrawal. Conclusion: We highlight an excellent survival rate and suggest risk classifications of persistent and recurrent disease based on the numbers of LN metastases and ECE-LN, LN metastases location, tumor size, and thyroglobulin level.

scholarly journals Performance of the American Thyroid Association Risk Classification in a Single Center Cohort of Pediatric Patients with Differentiated Thyroid Cancer: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Raad Alwithenani ◽  
Sarah DeBrabandere ◽  
Irina Rachinsky ◽  
S. Danielle MacNeil ◽  
Mahmoud Badreddine ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
High Risk ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Risk Classification ◽  
American Thyroid Association ◽  
Persistent Disease

Introduction. Differentiated thyroid cancer (DTC) is the most common endocrine malignancy in children. Retrospective studies show conflicting results regarding predictors of persistent and recurrent disease after initial therapy. In 2015, the American Thyroid Association (ATA) proposed a clinical classification system to identify pediatric thyroid cancer patients at risk for persistent/recurrent disease. Material and Methods. We retrospectively included all patients in our registry diagnosed with papillary DTC at ≤ 18 years of age. We analyzed the prognostic performance of the ATA classification and other risk factors for predicting response to initial treatment and final outcome in pediatric DTC. Results. We included 41 patients, 34 females and 7 males, diagnosed with papillary DTC at a mean (SD) age of 16.2 (1.8) years. Based on the ATA pediatric risk classification, patients were categorized as low (61%), intermediate (10%), or high risk (29%). The median follow-up period was 7.3 (1-41) years. After initial treatment, disease free status was achieved in 92%, 50%, and 42% of the low, intermediate, and high risk groups, respectively (P <0.01). At the last visit, persistent disease was present in 12%, 25%, and 33% (P=0.27). Assessing other risk factors, only the presence of distant metastases at diagnosis resulted in increased presence of persistent disease at last follow-up (P=0.03). Conclusion. This study supports the clinical relevance of the ATA risk classification for predicting the response to initial treatment. There was no clear prediction of long-term outcome, but this may be due to limited power caused by the small number of patients.

scholarly journals Identification of Intermediate- to High-Risk Papillary Thyroid Carcinoma Patients Who May Be Safely Managed without the Performance of Delayed Stimulated Thyroglobulin Measurements following Total Thyroidectomy and Radioactive Iodine Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Kyung-Hee Kim ◽  
Min-Hee Kim ◽  
Ye-Jee Lim ◽  
Ihn Suk Lee ◽  
Ja-Seong Bae ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Thyroidectomy ◽  
Radioactive Iodine ◽  
Significant Risk ◽  
Disease Status ◽  
Radioactive Iodine Therapy ◽  
Papillary Thyroid ◽  
Independent Risk Factors

Background. The measurement of stimulated thyroglobulin (sTg) after total thyroidectomy and remnant radioactive iodine (RAI) ablation is the gold standard for monitoring disease status in patients with papillary thyroid carcinomas (PTCs). The aim of this study was to determine whether sTg measurement during follow-up can be avoided in intermediate- and high-risk PTC patients.Methods. A total of 346 patients with PTCs with an intermediate or high risk of recurrence were analysed. All of the patients underwent total thyroidectomy as well as remnant RAI ablation and sTg measurements. Preoperative and postoperative parameters were included in the analysis.Results. Among the preoperative parameters, age below 45 years and preoperative Tg above 19.4 ng/mL were significant risk factors for predicting detectable sTg during follow-up. Among the postoperative parameters, thyroid capsular invasion, lymph node metastasis, and ablative Tg above 2.9 ng/mL were independently correlated with a detectable sTg range. The combination of ablative Tg less than 2.9 ng/mL with pre- and postoperative independent risk factors for detectable sTg increased the negative predictive value for detectable sTg up to 98.5%.Conclusions. Based on pre- and postoperative parameters, a substantial proportion of patients with PTCs in the intermediate- and high-risk classes could avoid aggressive follow-up measures.

scholarly journals Microscopic Positive Tumor Margin Increases Risk for Disease Persistence but Not Recurrence in Patients with Stage T1-T2 Differentiated Thyroid Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Olfat Kamel Hasan ◽  
Sarah De Brabandere ◽  
Irina Rachinsky ◽  
David Laidley ◽  
Danielle MacNeil ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Positive Margin ◽  
Disease Recurrence ◽  
Low Risk ◽  
Recurrence Rates ◽  
Persistent Disease ◽  
Positive Margins

Introduction. Differentiated thyroid cancer (DTC) has an overall excellent prognosis. Patients who develop recurrent disease have a more unfavorable disease course than those with no recurrence. Higher recurrence rates are seen with incomplete surgical resection and gross positive margins. It is unclear whether microscopic positive margin affects disease recurrence rates as much as grossly positive margin. Aim of the Study. To assess whether microscopic positive margin is an independent predictor of disease recurrence in patients with overall low-risk DTC. Patients and Methods. We conducted a retrospective single-center institutional review of 1,583 consecutive patients’ charts from 1995–2013 using the Canadian Thyroid Cancer Consortium Registry. We included adult patients with nonmetastasizing T1 and T2 DTC with a minimum of three years follow-up. Univariate and multivariate analyses were used to study factors that may influence the risk of persistent/recurrent disease. Strict definitions of persistent versus recurrent disease were applied. Results. 963 patients (152 men and 811 women) were included in the study with a mean age of 46 years. Microscopic positive margins were present in 12% of the specimens and were associated with an increased rate of persistent disease (8% versus 2% in the controls) but not with an increased risk of recurrent disease (1% in both groups). T2 tumors had a significantly higher incidence of positive margins than T1 tumors (48% versus 36%) and significantly higher nodal staging. Conclusions. Microscopic positive margin in the histopathology report in patients with low-risk DTC was associated with a higher rate of persistent disease but did not increase the risk of disease recurrence. A close follow-up of biomarkers and occult residual cancerous lesions is needed, especially in the first year. Further studies are needed to determine whether additional therapeutic measures to prevent recurrence are indicated in T1 and T2 DTC with positive microscopic surgical margins.

scholarly journals Time to Separate Persistent From Recurrent Differentiated Thyroid Cancer: Different Conditions With Different Outcomes

2018 ◽  
Vol 104 (2) ◽  
pp. 258-265 ◽  
Author(s):  
Giulia Sapuppo ◽  
Martina Tavarelli ◽  
Antonino Belfiore ◽  
Riccardo Vigneri ◽  
Gabriella Pellegriti
Keyword(s):  
Thyroid Cancer ◽  
Initial Treatment ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Treatment Strategies ◽  
Distant Metastases ◽  
Persistent Disease ◽  
Tertiary Referral Center ◽  
N Status

Abstract Context Differentiated thyroid cancer (DTC) has an excellent prognosis, but up to 20% of patients with DTC have disease events after initial treatment, indistinctly defined as persistent/recurrent disease. Objective To evaluate the prevalence and outcome of “recurrent” disease (relapse after being 12 months disease-free) compared with “persistent” disease (present ab initio since diagnosis). Design Retrospective analysis of persistent/recurrent disease in patients with DTC (1990 to 2016) with 6.5 years of mean follow-up. Setting Tertiary referral center for thyroid cancer. Patients In total, 4292 patients all underwent surgery ± 131I treatment of DTC. Main Outcome Measures DTC cure of disease persistence or recurrence. Results A total of 639 of 4292 (14.9%) patients had disease events after initial treatment, most (498/639, 78%) with persistent disease and 141 (22%) with recurrent disease. Relative to patients with recurrent disease, patients with persistent disease were significantly older (mean age 46.9 vs 45.7 years) and with a lower female to male ratio (1.9/1 vs 4.8/1). Moreover, in this group, structured disease was more frequent (65.7% vs 41.1%), and more important, distant metastases were significantly more frequent (38.4% vs 17.0%). At multivariate analysis, male sex (OR = 1.7), age (OR = 1.02), follicular histotype (OR = 1.5), T status (T3; OR = 3), and N status (N1b; OR = 7.7) were independently associated with persistent disease. Only the N status was associated with recurrent disease (N1b; OR = 2.5). Conclusions In patients with DTC not cured after initial treatment, persistent disease is more common and has a worse outcome than recurrent disease. Postoperative status evaluated during first-year follow-up may have important clinical implications for planning tailored treatment strategies and long-term follow-up procedures.

scholarly journals Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients

2013 ◽  
Vol 169 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Maria Grazia Castagna ◽  
Gabriele Cevenini ◽  
Alexandra Theodoropoulou ◽  
Fabio Maino ◽  
Silvia Memmo ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Recurrent Disease ◽  
Intermediate Risk ◽  
Persistent Disease ◽  
Thyroid Ablation ◽  
The Impact

BackgroundIn differentiated thyroid cancer (DTC) patients at intermediate risk of recurrences, no evidences are provided regarding the optimal radioactive iodine (RAI) activity to be administered for post-surgical thyroid ablation.MethodsThis study aimed to evaluate the impact of RAI activities on the outcome of 225 DTC patients classified as intermediate risk, treated with low (1110–1850 MBq) or high RAI activities (≥3700 MBq).ResultsSix to 18 months after ablation, remission was observed in 60.0% of patients treated with low and in 60.0% of those treated with high RAI activities, biochemical disease was found in 18.8% of patients treated with low and in 14.3% of patients treated with high RAI activities, metastatic disease was found in 21.2% of patients treated with low and in 25.7% of patients treated with high RAI activities (P=0.56). At the last follow-up (low activities, median 4.2 years; high activities, median 6.9 years), remission was observed in 76.5% of patients treated with low and in 72.1% of patients treated with high RAI activities, persistent disease was observed in 18.8% of patients treated with low and in 23.5% of patients treated with high RAI activities, recurrent disease was 2.4% in patients treated with low and 2.1% in patients treated with high RAI activities, deaths occurred in 2.4% of patients treated with low and in 2.1% of patients treated with high RAI activities (P=0.87).ConclusionOur study provides the first evidence that in DTC patients at intermediate risk, high RAI activities at ablation have no major advantage over low activities.

scholarly journals Recurrence of differentiated thyroid cancer in the elderly

2013 ◽  
Vol 168 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Christopher S Hollenbeak ◽  
Melissa M Boltz ◽  
Eric W Schaefer ◽  
Brian D Saunders ◽  
David Goldenberg
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Elderly Patients ◽  
Differentiated Thyroid Cancer ◽  
Recurrent Disease ◽  
Significant Risk ◽  
Cox Proportional Hazards ◽  
Competing Risk ◽  
Well Differentiated ◽  
The Impact

ObjectiveData from the Surveillance Epidemiology and End Results Medicare-linked database were used to estimate the incidence of and risk factors associated with recurrent thyroid cancer, and to assess the impact of recurrence on mortality following diagnosis, controlling for mortality as a competing risk.DesignWe identified 2883 patients over 65 years of age diagnosed with a single, primary well-differentiated thyroid cancer between 1995 and 2007. A recurrence was considered if the patient had evidence of I-131 therapy, imaging for metastatic thyroid carcinoma, or complete thyroidectomy beyond 6 months of diagnosis. Competing risk regressions were performed using Cox proportional hazards models with 1- and 2-year landmarks.ResultsRecurrence was observed in 1117 (39%) of the 2883 patients in the cohort. Age, stage, and treatment status were significant risk factors for developing recurrent disease (P<0.0001). Patients with recurrent disease had a higher risk of all-cause mortality within 10 years of diagnosis than patients with no recurrence at 1- and 2-year landmarks. Patients with follicular histology and a recurrence were less likely to die from cancer (hazard ratio 0.54; P=0.03) than patients with no recurrence.ConclusionsThe rate of recurrence of well-differentiated thyroid carcinomas in this sample of elderly patients was 39%. Extent of disease and older age negatively impacted the risk of recurrence from differentiated thyroid cancer. In these data, patients with follicular histology and a recurrence were less likely to die, suggesting that mortality and recurrence are competing risks. These data should be taken into account with individualized treatment strategies for elderly patients with recurrent malignant thyroid disease.

scholarly journals Recurrence Factors and Characteristic Trends of Papillary Thyroid Cancer Over Three Decades

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A869-A869
Author(s):  
Waralee Chatchomchuan ◽  
Yotsapon Thewjitcharoen ◽  
Krittadhee Karndumri ◽  
Sriurai Porramatikul ◽  
Sirinate Krittiyawong ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Survival Rate ◽  
Recurrent Disease ◽  
Disease Free Survival ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Factors Associated ◽  
Disease Free Survival Rate ◽  
Disease Free

Abstract Background: The prevalence of thyroid cancer is rising worldwide. Although thyroid cancer has a favorable prognosis, up to 20% of patients experienced recurrent disease at some point during follow-up. The present study aimed to examine the recurrent factors that determined the outcomes of papillary thyroid cancer (PTC) and the characteristic trends in Thai patients over the last 30 years in a single institute. Methods: We reviewed the clinical data of all patients with PTC who were treated between 1987 and 2019. Clinical characteristics, epidemic trends, factors associated with the persistent or recurrent disease, disease-specific survival rate and disease-free survival rate were analysed. Results: A total of 235 patients with PTC who were registered between 1987 and 2019 were reviewed. The mean age was 41.0 ± 14.3 years, with a mean follow-up of 113 months. Papillary thyroid microcarcinoma (PTMC) was consistently increased and accounted for 21.4% (50/235) of total cases. According to American Thyroid Association (ATA) risk stratification, high ATA risk was found 24% of all PTMCs in the last decade, and 16.7% of these patients experienced local recurrence during the follow-up period. Coexistence with Hashimoto’s thyroiditis (HT) was found in one-fifth of the patients with PTC and was correlated with a low recurrent rate (HR 0.21, p = 0.009). Factors associated with the persistent or recurrent of disease included age &gt; 55 years and high ATA risk. The overall disease-free survival rate and disease-specific survival rate were 77.4% and 98.3%, respectively. Conclusions: The prognosis of PTC is generally considered favorable. However, more than one-third of patients with PTMC demonstrated more aggressive clinical behavior, particularly in the last decade of the study. Coexistence with HT might contribute to a better prognosis in cases of PTC.

scholarly journals Is Stimulated Thyroglobulin Necessary after Ablation in All Patients with Papillary Thyroid Carcinoma and Basal Thyroglobulin Detectable by a Second-Generation Assay?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Pedro Weslley Rosario ◽  
Gabriela Franco Mourão ◽  
Maria Regina Calsolari
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Recurrent Disease ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Neck Ultrasound ◽  
Persistent Disease ◽  
Risk Patients ◽  
Node Metastases

Objective. To evaluate the percentage of elevated stimulated thyroglobulin (sTg) and persistent or recurrent disease (PRD) in patients with detectable basal Tg < 0.3 ng/mL.Methods. The sample consisted of 130 patients with papillary thyroid carcinoma (PTC) who were at low risk of PRD and who had neck ultrasound (US) without abnormalities, negative anti-Tg antibodies (TgAb), and detectable basal Tg < 0.3 ng/mL about 6 months after ablation.Results. sTg was <1 ng/mL in 88 patients (67.7%), between 1 and 2 ng/mL in 26 (20%), and ≥2 ng/mL in 16 (12.3%). Imaging methods revealed the absence of tumors in 16 patients with elevated sTg. During follow-up, Tg increased to 0.58 ng/mL in one patient and lymph node metastases were detected. Sixty-nine patients continued to have detectable Tg < 0.3 ng/mL and US revealed recurrence in only one patient. Sixty patients progressed to persistently undetectable Tg without apparent disease on US.Conclusions. In low-risk patients with PTC who have detectable basal Tg < 0.3 ng/mL after ablation, negative TgAb, and US, persistent disease is rare and eventual recurrences can be detected by basal Tg elevation and/or subsequent US assessments, with follow-up without sTg being an “alternative” to Tg stimulation.

Sign in / Sign up

Export Citation Format

Share Document