Predictors of recurrence after total thyroidectomy plus neck dissection and radioactive iodine ablation for high-risk papillary thyroid carcinoma.

Abstract

BACKGROUND:

American Thyroid Association (ATA) proposed management guidelines for differentiated thyroid cancer, including a three-tiered risk stratification system for structural recurrence. This study aimed to compare the various 2015 ATA criteria for the strength of association with the recurrence of high-risk papillary thyroid carcinoma (PTC).

STUDY DESIGN:

This study included 545 consecutive patients who underwent total thyroidectomy plus neck dissection and radioactive iodine ablation (RAI) for previously untreated high-risk PTC. The association of recurrence-free survival (RFS) with clinicopathological factors was evaluated by univariate and multivariate Cox proportional hazard regression analyses.

RESULTS:

During a follow-up median period of 89 months, 90 (16.5%) patients had any-site recurrence. Of the high-risk factors, high stimulated thyroglobulin (sTg) level and >3-cm sized lymph nodes (LNs) were significantly associated with recurrence (all P < .005). Sex, tumor size, lymphovascular invasion, multifocality, number of positive LNs, extranodal extension, T and N classifications, and overall tumor-node-metastasis stage were also significantly associated with recurrence (all P < .05). In multivariate analyses, high sTg level [adjusted hazard ratio (HR) = 7.18] and N1b (adjusted HR = 3.27) were independent factors predictive of recurrence (all P ≤ .001).

CONCLUSIONS:

Postoperative high serum sTg level might be the most important predictor of PTC recurrence after total thyroidectomy plus neck dissection and RAI.

• Authors: Yonghan Kim, Jong-Lyel Roh, Dongeun Song, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim
• Journal: Journal of surgical oncology (J Surg Oncol) Vol. 122 Issue 5 Pg. 906-913 (Oct 2020) ISSN: 1096-9098 [Electronic] United States
• PMID: 32588461 (Publication Type: Journal Article)
• Copyright: © 2020 Wiley Periodicals LLC.

Chemical References

• Iodine Radioisotopes

Topics

• Ablation Techniques (methods)
• Adult
• Disease-Free Survival
• Female
• Humans
• Iodine Radioisotopes (administration & dosage)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (pathology)
• Neoplasm Staging
• Proportional Hazards Models
• Risk Factors
• Thyroid Cancer, Papillary (pathology, radiotherapy, surgery)
• Thyroid Neoplasms (pathology, radiotherapy, surgery)
• Thyroidectomy (methods)