Papillary Thyroid Carcinoma Patients Assessed to Be at Low or Intermediary Risk After Primary Treatment Are at Greater Risk of Long Term Recurrence If They Are Thyroglobulin Antibody Positive Or Do Not Have Distinctly Low Thyroglobulin at Initial Assessment
- 1 December 2011
- journal article
- research article
- Published by Mary Ann Liebert Inc in Thyroid®
- Vol. 21 (12), 1301-1308
- https://doi.org/10.1089/thy.2011.0122
Abstract
Background: In papillary thyroid carcinoma (PTC), recurrences during long-term follow-up (R-LTFU) occur even in those who appear to have an excellent prognosis after initial thyroid surgery and usually, radioactive iodine (i.e., “primary treatment”). Initial studies that predict R-LTFU are not well defined. Values for serum thyroglobulin (Tg) measurements when serum thyrotropin (TSH) is >30 μU/mL, as a result of either recombinant TSH or L-thyroxine withdrawal, referred to here as stimulated Tg (STg), have been previously evaluated. The aim of the current study was to determine the parameters associated with R-LTFU in patients with PTC categorized as having low-risk disease 9 to 12 months after their primary treatment. Methods: This was a retrospective study of 469 patients with PTC with a mean follow-up 5.8±3.9 years. Study patients had to have no uptake in the first postablative diagnostic 131iodine whole body scan (WBS) performed 9–12 months after primary treatment, a normal cervical ultrasonography (C-US), and STg of Results: Twelve patients developed recurrences (2.6%) in cervical region. Greater tumor size, higher STg, and positive anti-Tg tests at initial evaluation were associated with greater R-LTFU. The recurrence rates were 1.5% (7/450) and 26% (5/19), respectively, in patients with negative and positive anti-Tg tests at initial evaluation. Recurrence-free survival was lower in the patients with initial lymph node metastases, positive anti-Tg tests, and STg of ≥0.3 ng/mL at the first postablative WBS (p=0.022, 0.001, 0.035, respectively, by log-rank test). Regression analysis in patients who were anti-Tg negative revealed that STg ≥0.3 ng/mL at this first WBS was the only parameter related to recurrence (p=0.031, odds ratio: 10.30, confidence interval: 1.23–83.3). Conclusion: Patients with PTC traditionally categorized as low risk during their first 9 to 12 months after primary treatment have a greater risk of R-LTFU if their postablative STg is ≥0.3 ng/mL, or they have positive anti-Tg, even at this early stage. Periodic C-US is important in these patients and should probably be more frequent in patients with PTC who have positive anti-Tg tests or STg ≥0.3 ng/mL in the first year after diagnosis.Keywords
This publication has 17 references indexed in Scilit:
- Thyroid Cancer Recurrence in Patients Clinically Free of Disease with Undetectable or Very Low Serum Thyroglobulin ValuesJournal of Clinical Endocrinology & Metabolism, 2010
- Post-ablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up studyActa Endocrinologica, 2010
- Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid CancerThyroid®, 2009
- Follow-Up of Low-Risk Differentiated Thyroid Cancer Patients Who Underwent Radioiodine Ablation of Postsurgical Thyroid Remnants after Either Recombinant Human Thyrotropin or Thyroid Hormone WithdrawalJournal of Clinical Endocrinology & Metabolism, 2009
- European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epitheliumActa Endocrinologica, 2006
- Radioiodine Ablation of Thyroid Remnants after Preparation with Recombinant Human Thyrotropin in Differentiated Thyroid Carcinoma: Results of an International, Randomized, Controlled StudyJournal of Clinical Endocrinology & Metabolism, 2006
- A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years LaterJournal of Clinical Endocrinology & Metabolism, 2005
- Clinical Behavior and Outcome of Papillary Thyroid Cancers Smaller than 1.5 cm in Diameter: Study of 299 CasesJournal of Clinical Endocrinology & Metabolism, 2004
- A Consensus Report of the Role of Serum Thyroglobulin as a Monitoring Method for Low-Risk Patients with Papillary Thyroid CarcinomaJournal of Clinical Endocrinology & Metabolism, 2003
- TNM residual tumor classification revisitedCancer, 2002