Abstract | AIM: We aimed to analyze the prognostic factors affecting disease-specific survival in patients with recurrent and/or metastatic differentiated thyroid carcinoma. METHODS: Seventy-seven patients with recurrent/metastatic differentiated thyroid carcinoma who were previously treated with total thyroidectomy followed by radioactive iodine therapy were enrolled. Recurrent/metastatic disease was detected by positron emission tomography/computed tomography. At the time of last follow-up (mean 4.8±1.3 years), patients were grouped as having (i) clinical remission (n=17), (ii) stable disease (n=22), or (iii) progressive disease (n=38). We retrospectively examined the prognostic impact of clinical factors (age, sex, TNM stage), histopathological factors of the primary tumor ( tumor size, histology, the presence of vascular invasion, extrathyroidal spread, and lymph node metastasis), serum thyroglobulin levels, and metabolic parameters of recurrent/metastatic disease such as radioactive iodine avidity, F18-fluorodeoxyglucose uptake (SUVmax) in metastatic deposits, number and location of F18-fluorodeoxyglucose-avid lesions (locoregional vs. distant), and the impact of surgery on disease-specific survival. RESULTS: Lack of vascular invasion (p=0.04), presence of surgically amenable recurrence/ metastasis (p=0.0001), and suppressible on- therapy serum thyroglobulin levels at the time of recurrent/metastatic disease (p=0.01) were strong predictors of clinical remission and good prognosis on multivariate analysis. Lesional SUVmax, number or location of F18-fluorodeoxyglucose-avid lesions, and TNM stage did not correlate with clinical outcome. Clinical remission could only be achieved by curative surgery. Patients without curative surgery for recurrence/ metastasis had a 43 times higher risk to develop progressive disease than patients with disease amenable to surgery. CONCLUSIONS: Curative surgery is an essential therapeutic modality to achieve clinical remission in metastatic/recurrent differentiated thyroid carcinoma. Positron emission tomography/computed tomography is a powerful method to detect surgically resectable disease for the selection of patients who may benefit from curative surgery.
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Authors | Burcu Esen Akkas, Busra Bedriye Demirel, Gulin Ucmak Vural |
Journal | Thyroid : official journal of the American Thyroid Association
(Thyroid)
Vol. 24
Issue 2
Pg. 287-95
(Feb 2014)
ISSN: 1557-9077 [Electronic] United States |
PMID | 23750862
(Publication Type: Journal Article)
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Chemical References |
- Iodine Radioisotopes
- Fluorodeoxyglucose F18
- Thyroglobulin
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Female
- Fluorodeoxyglucose F18
- Humans
- Iodine Radioisotopes
(therapeutic use)
- Kaplan-Meier Estimate
- Lymphatic Metastasis
(diagnosis, pathology)
- Male
- Middle Aged
- Neoplasm Recurrence, Local
(pathology)
- Positron-Emission Tomography
- Prognosis
- Remission Induction
- Retrospective Studies
- Thyroglobulin
(blood)
- Thyroid Neoplasms
(mortality, pathology, radiotherapy, surgery)
- Thyroidectomy
- Tomography, X-Ray Computed
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