Prognostic factors related with recurrence in papillary thyroid cancer
Keywords:
thyroid neoplasms, therapy, papillary carcinoma, thyroidectomy, Instituto Nacional de Cancerología - Colombia, thyroglobulin, risk factorsAbstract
Introduction: Carcinoma of the thyroid gland is an uncommon cancer but is the most common malignancy of the endocrine system. Differentiated tumors (papillary or follicular) are highly treatable and usually curable.
Objective: The objective of this study was to determine the risk factors related with recurrent papillary thyroid carcinoma.
Materials and methods: Two hundred and thirty eight patients with well-differentiated papillary thyroid carcinoma followed for 5 years (range 1 to 9 years) were retrospectively evaluated to determine their risk factors for an increased relapse rate.
Results: 86% of these patients were initially treated with a total thyroidectomy, 6% with a subtotal thyroidectomy, and 8% with a lobectomy. Additionally, 52% underwent a central lymph node dissection and 25% had a lateral neck dissection. After surgery, 169 patients (6/%) underwent iodine ablation therapy (30-150 mCi).Two thirds of the patients were classified as stages I and II and 1/3 as stage III according to the TNM staging system. 52 patients had a relapse (50% during the first two years). In 46% of these patients, the relapse was exclusively identified by abnormal thyroglobulin levels. In patients with a relapse, the capsular extension of the tumour, with or without invasion of soft tissues, and the metastasis to the lymph nodes in the central and lateral neck compartments at diagnosis, constituted the most important determinant factors for an increased risk of relapse. Age, gender, and tumour multifocality and size were not significant determinants for a higher relapse rate. In patients in whom a complete central lymph node dissection was performed, a 74% reduction in their risk of relapse was observed. Similarly, iodine ablation therapy was associated with a reduction up to 89% in the risk of relapse in comparison with patients no treated with iodine.
Conclusions: Predictors of recurrent thyroid carcinoma are similar to that previously described in medical literature.
Author Biography
Gloria Garavito, Instituto Nacional de Cancerología
Grupo de Endocrinología, Instituto Nacional de Cancerología E.S.E., Bogotá, D.C., Colombia
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