Long-term Clinical Outcomes and Prognostic Factors for Patients with Papillary Thyroid Carcinoma with Other Organ Invasions After Adjuvant Radioactive Iodine

Overview

Journal Endocrine

Specialty Endocrinology

Date 2022 Nov 11

PMID 36367673

Authors

Terufumi Kawamoto

Naoto Shikama

Tatsuya Fukumori

Masae Hoshi

Tetsu Yamada

Affiliations

Soon will be listed here.

Abstract

Purpose: Papillary thyroid carcinoma (PTC) with other organ invasions is directly related to patient prognosis and quality of life; however, studies on the clinical outcomes of adjuvant radioactive iodine (RAI) for PTC with other organ invasions are limited. This study aimed to clarify the clinical outcomes and prognostic factors for patients with PTC with other organ invasions after adjuvant RAI.

Methods: Patients with PTC with other organ invasions without distant metastases who underwent surgery and adjuvant RAI were retrospectively reviewed. We evaluated the initial responses based on the American Thyroid Association guidelines and survival rates. Prognostic factors for locoregional recurrence-free survival (LRRFS) were analyzed.

Results: Between January 2005 and December 2019, 102 patients were included in the study. Their median age was 55 years. The median follow-up duration was 92 months (range; 30-231 months). The excellent response rate after RAI was 42%. The 7-year overall survival, LRRFS, and recurrence-free survival rates were 100%, 75%, and 75%, respectively. Metastatic lymph node size, resection margin status, and post-RAI suppressed thyroglobulin level were the independent prognostic factors for LRRFS.

Conclusion: We demonstrated that 75% of patients with PTC with other organ invasions could achieve long-term survival without recurrence after adjuvant RAI. Future development of effective treatment strategies for large metastatic lymph nodes, gross residual tumors, and high serum thyroglobulin levels is warranted.

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References

Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R . Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013; 2013:965212. PMC: 3664492. DOI: 10.1155/2013/965212. View

Haugen B, Alexander E, Bible K, Doherty G, Mandel S, Nikiforov Y . 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015; 26(1):1-133. PMC: 4739132. DOI: 10.1089/thy.2015.0020. View

Cooper D, Doherty G, Haugen B, Hauger B, Kloos R, Lee S . Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167-214. DOI: 10.1089/thy.2009.0110. View

Kruijff S, Aniss A, Chen P, Sidhu S, Delbridge L, Robinson B . Decreasing the dose of radioiodine for remnant ablation does not increase structural recurrence rates in papillary thyroid carcinoma. Surgery. 2014; 154(6):1337-44. DOI: 10.1016/j.surg.2013.06.034. View

Han J, Kim W, Kim T, Jeon M, Ryu J, Song D . Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension. Thyroid. 2013; 24(5):820-5. PMC: 4026370. DOI: 10.1089/thy.2013.0362. View

Sabra M, Grewal R, Ghossein R, Tuttle R . Higher administered activities of radioactive iodine are associated with less structural persistent response in older, but not younger, papillary thyroid cancer patients with lateral neck lymph node metastases. Thyroid. 2014; 24(7):1088-95. DOI: 10.1089/thy.2013.0465. View

Gray K, Bannani S, Caillard C, Amanat S, Ullmann T, Romanov P . High-dose radioactive iodine therapy is associated with decreased risk of recurrence in high-risk papillary thyroid cancer. Surgery. 2018; 165(1):37-43. DOI: 10.1016/j.surg.2018.04.059. View

Jeong S, Lee S, Kim W, Jung J, Lee W, Ahn B . Clinical outcomes of patients with T4 or N1b well-differentiated thyroid cancer after different strategies of adjuvant radioiodine therapy. Sci Rep. 2019; 9(1):5570. PMC: 6447529. DOI: 10.1038/s41598-019-42083-3. View

Watanabe K, Igarashi T, Uchiyama M, Ojiri H . Relapse-free survival after adjuvant radioactive iodine therapy in patients with differentiated thyroid carcinoma with a microscopically positive tumor margin. Ann Nucl Med. 2020; 34(12):920-925. DOI: 10.1007/s12149-020-01523-1. View

10.

Kim K, Bae J, Kim J . Long-Term Oncological Outcome Comparison between Intermediate- and High-Dose Radioactive Iodine Ablation in Patients with Differentiated Thyroid Carcinoma: A Propensity Score Matching Study. Int J Endocrinol. 2021; 2021:6642971. PMC: 7929686. DOI: 10.1155/2021/6642971. View

11.

Shindo M, Caruana S, Kandil E, McCaffrey J, Orloff L, Porterfield J . Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck. 2014; 36(10):1379-90. DOI: 10.1002/hed.23619. View

12.

Chow S, Yau S, Kwan C, Poon P, Law S . Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition. Endocr Relat Cancer. 2006; 13(4):1159-72. DOI: 10.1677/erc.1.01320. View

13.

Mazzaferri E, Jhiang S . Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97(5):418-28. DOI: 10.1016/0002-9343(94)90321-2. View

14.

Ito Y, Onoda N, Okamoto T . The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr J. 2020; 67(7):669-717. DOI: 10.1507/endocrj.EJ20-0025. View

15.

Sanabria A, Rojas A, Arevalo J, Kowalski L, Nixon I . Microscopically positive surgical margins and local recurrence in thyroid cancer. A meta-analysis. Eur J Surg Oncol. 2019; 45(8):1310-1316. DOI: 10.1016/j.ejso.2019.02.007. View

16.

Terezakis S, Lee K, Ghossein R, Rivera M, Tuttle R, Wolden S . Role of external beam radiotherapy in patients with advanced or recurrent nonanaplastic thyroid cancer: Memorial Sloan-kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 2008; 73(3):795-801. DOI: 10.1016/j.ijrobp.2008.05.012. View

17.

Romesser P, Sherman E, Shaha A, Lian M, Wong R, Sabra M . External beam radiotherapy with or without concurrent chemotherapy in advanced or recurrent non-anaplastic non-medullary thyroid cancer. J Surg Oncol. 2014; 110(4):375-82. PMC: 10152973. DOI: 10.1002/jso.23656. View

18.

Schwartz D, Lobo M, Ang K, Morrison W, Rosenthal D, Ahamad A . Postoperative external beam radiotherapy for differentiated thyroid cancer: outcomes and morbidity with conformal treatment. Int J Radiat Oncol Biol Phys. 2008; 74(4):1083-91. PMC: 2745400. DOI: 10.1016/j.ijrobp.2008.09.023. View

19.

Kiess A, Agrawal N, Brierley J, Duvvuri U, Ferris R, Genden E . External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society. Head Neck. 2015; 38(4):493-8. PMC: 4975923. DOI: 10.1002/hed.24357. View

20.

Randolph G, Duh Q, Heller K, LiVolsi V, Mandel S, Steward D . The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012; 22(11):1144-52. DOI: 10.1089/thy.2012.0043. View