When treated with total thyroidectomy and routine postoperative iodine 131 ablation, patients with well-differentiated thyroid carcinoma who present with neck node metastases outside the central compartment of the neck have an approximately 6-fold risk of developing recurrences, most of which occur in the neck.

Background:The AMES (age, distant metastasis, tumor extent, and size), AGES (age, tumor size, histologic grade, tumor extent, distant metastasis), and MACIS (distant metastasis, age, completeness of primary tumor resection, local invasion, and tumor size) prognostic systems for welldifferentiated thyroid carcinoma (WDTC) are well known. The development of disease recurrence is associated with a poor outcome; however, the prognostic importance of multiple treatment failures has not been clearly reported.Objectives: To identify patient, tumor, and treatment factors that may be associated with the development of multiple recurrences in WDTC.Design and Setting: All patients treated for residual or recurrent WDTC were retrospectively identified from the thyroid cancer database at the Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario (1963-2000. Data on relevant patient, tumor, and treatment factors were collected. Main Outcome Measures: Patient, tumor, and treatment factors predicting the development of multiple treatment failures, disease-specific survival, and overall survival.Results: A total of 574 patients (115 male, 459 female; median age, 42 years [range, 9-92 years]) were identified, whose final histopathologic diagnosis was papillary carcinoma in 468, follicular carcinoma in 76, and ORIGINAL ARTICLE

Objectives/Hypothesis The objective was to compare the rate and site of recurrences in patients with well‐differentiated thyroid carcinoma who underwent a central compartment dissection, a posterolateral neck dissection, or a combination of both procedures. Study Design Retrospective chart review. Methods The charts of 522 consecutive patients with well‐differentiated thyroid carcinoma were reviewed, and 74 patients who had undergone a neck dissection were identified. The rates of recurrence in three sites were noted: the central compartment nodes (levels VI, superior mediastinum), posterolateral compartment neck nodes (levels II–V), and distant sites. These rates were compared in patients who underwent a central compartment dissection (level VI, superior mediastinum) and in patients who underwent a posterolateral neck dissection (levels II–V). Results Six patients underwent only a central compartment dissection, 47 patients had only a posterolateral neck dissection, and 21 patients had both a central compartment and a posterolateral neck dissection. In these three groups there were zero, two, and two central compartment node recurrences; two, nine, and seven posterolateral neck recurrences; and zero, two, and three distant recurrences, respectively. There were no significant differences in the rate of recurrence in any of the three sites examined between any of the three treatment groups (Fisher's Exact test, all P values > .20). Conclusion In patients with well‐differentiated thyroid carcinoma, dissection of only the central or posterolateral compartments of the neck with clinical or radiographic evidence of disease is advocated.

WDTC is associated with a significant recurrence rate but good disease-specific survival. The most important prognostic factors are family history of WDTC, extent of surgical treatment (i.e., total thyroidectomy), and advanced initial stage of disease, with a trend for age 60 years and older.

Filipino patients have a significantly higher risk of thyroid cancer recurrence compared with non-Filipino patients. However, no significant difference was noted in the time to recurrence or the rate of death from disease. These findings justify a more aggressive initial management and follow-up regimen for Filipino patients with thyroid cancer.