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Recurrent differentiated thyroid carcinoma: Biological implications of age, method of detection, and site and extent of recurrence

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Abstract

Background

We identified factors predictive of outcome for recurrent differentiated thyroid carcinoma (DTC).

Methods

Fifty-seven patients with local (LR), regional (RRec), and/or distant recurrence (DR) of 431 recurrent DTCs were studied. Disease-specific survival (DSS) rate was estimated with the Kaplan-Meier method. Univariate and multivariate comparisons were conducted by log-rank and Cox regression analysis.

Results

The median follow-up was 13 years. Distribution of the first relapse was LR only (35%), LR and RRec (23%), LR and DR (30%), and LR, RRec, and DR (12%). Factors predictive of resectability were a long (≥5-year) disease-free interval (DFI) and subclinical and thyroid remnant recurrence. Only 26% of symptomatic and 45% of thyroid bed LR, and 43% with DFI<5 years, could be resected completely. No isolated thyroid remnant and 75% of thyroid bed LR resulted in tumor-related mortality. Age <45 years, subclinical recurrence, isolated LR, and the ability to render the patient disease free independently predicted DSS. Fifteen-year DSS for LR only; LR and RRec; LR and DR; and LR, RRec, and DR were 49%, 28%, 15%, and 0%, respectively.

Conclusions

Isolated thyroid remnant recurrence defines a benign phenotype. Age, method of detection, site and extent of recurrence, and the ability to render the patient disease free predict outcome for recurrent DTC. Multimodality long-term follow-up is warranted to detect recurrence at a subclinical potentially curative stage.

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References

  1. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995.Cancer 1998;83:2638–48.

    Article  PubMed  CAS  Google Scholar 

  2. Rossi RL, Cady B, Silverman ML, Wool MS, Horner TA. Current results of conservative surgery for differentiated thyroid carcinoma.World J Surg 1986;10:612–22.

    Article  PubMed  CAS  Google Scholar 

  3. Sanders LE, Silverman M. Follicular and Hürthle cell carcinoma: predicting outcome and directing therapy.Surgery 1998;124:967–74.

    PubMed  CAS  Google Scholar 

  4. Sanders LE, Cady B. Differentiated thyroid cancer. Reexamination of risk groups and outcome of treatment.Arch Surg 1998;133:419–25.

    Article  PubMed  CAS  Google Scholar 

  5. Stojadinovic A, Ghossein RA, Hoos A, et al. Hürthle cell carcinoma: a critical histopathological appraisal.J Clin Oncol 2001;19:2616–25.

    PubMed  CAS  Google Scholar 

  6. Tollefsen HR, Shah JP, Huvos AG. Papillary carcinoma of the thyroid. Recurrence in the gland after initial surgical treatment.Am J Surg 1972;124:468–72.

    Article  PubMed  CAS  Google Scholar 

  7. Mazzaferri EL, Young RL, Oertel JE, Kemmerer WT, Page CP. Papillary thyroid carcinoma: the impact of therapy in 576 patients.Medicine 1977;56:171–96.

    Article  PubMed  CAS  Google Scholar 

  8. McConahey WM, Hay ID, Woolner LB, van Heerden JA, Taylor WF. Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy and outcome.Mayo Clin Proc 1986;61:978–96.

    PubMed  CAS  Google Scholar 

  9. Grant CS, Hay ID, Gough IR, Bergstralh EJ, Goellner JR, McConahey WM. Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important?Surgery 1988;104:954–62.

    PubMed  CAS  Google Scholar 

  10. Coburn M, Teates D, Wanebo HJ. Recurrent thyroid cancer: role of surgery versus radioactive iodine (I131)Ann Surg 1994;219:587–95.

    Article  PubMed  CAS  Google Scholar 

  11. Harwood J, Clark OH, Dunphy JE. Significance of lymph node metastasis in differentiated thyroid cancer.Am J Surg 1978;136:107–12.

    Article  PubMed  CAS  Google Scholar 

  12. McHenry CR, Rosen IB, Walfish PG. Prospective management of nodal metastases in differentiated thyroid cancer.Am J Surg 1991; 162:353–6.

    Article  PubMed  CAS  Google Scholar 

  13. Mazzaferri EL. Papillary thyroid carcinoma: factors influencing prognosis and current therapy.Semin Oncol 1987;14:315–32.

    PubMed  CAS  Google Scholar 

  14. Schlumberger M, Tubiana M, De Vathaire F. Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma.J Clin Endocrinol Metab 1986; 63:960–7.

    Article  PubMed  CAS  Google Scholar 

  15. Hamby LS, McGrath PC, Schwartz RW. Management of local recurrence of well-differentiated thyroid carcinoma.J Surg Res 1992;52:113–7.

    Article  PubMed  CAS  Google Scholar 

  16. Westbury C, Vini L, Fisher C, Harmer C. Recurrent differentiated thyroid cancer without elevation of serum thyroglobulin.Thyroid 2000;10:171–6.

    Article  PubMed  CAS  Google Scholar 

  17. Aschcraft MJ, Van Herle AJ. The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up of patients with treated differentiated thyroid cancer.Am J Med 1981;71:806–14.

    Article  Google Scholar 

  18. Tyler DS, Shaha AR, Udelsman RA, et al. Thyroid cancer: 1999 update.Ann Surg Oncol 2000;7:376–98.

    Article  PubMed  CAS  Google Scholar 

  19. Franceschi M, Kusic Z, Franceschi D, et al. Thyroglobulin determination, neck ultrasonography and iodine-131 whole-body scintigraphy in differentiated thyroid carcinoma.J Nucl Med 1996;37:446–51.

    PubMed  CAS  Google Scholar 

  20. Frilling A, Gorges R, Tecklenborg K, et al. Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma.Surgery 2000;128:1067–74.

    Article  PubMed  CAS  Google Scholar 

  21. Grigsby PW, Baglan K, Siegel BA. Surveillance of patients to detect recurrent thyroid carcinoma.Cancer 1999;85:945–51.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    Alexander Stojadinovic MD, Margo Shoup MD, Aviram Nissan MD, Jatin P. Shah MD, Murray F. Brennan MD & Ashok R. Shaha MD

  2. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Ronald A. Ghossein MD

Authors
  1. Alexander Stojadinovic MD
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  2. Margo Shoup MD
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  3. Aviram Nissan MD
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  4. Ronald A. Ghossein MD
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  5. Jatin P. Shah MD
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  6. Murray F. Brennan MD
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  7. Ashok R. Shaha MD
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Corresponding author

Correspondence to Alexander Stojadinovic MD.

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Stojadinovic, A., Shoup, M., Nissan, A. et al. Recurrent differentiated thyroid carcinoma: Biological implications of age, method of detection, and site and extent of recurrence. Annals of Surgical Oncology 9, 789–798 (2002). https://doi.org/10.1007/BF02574502

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  • DOI: https://doi.org/10.1007/BF02574502

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