Long-Term Surveillance of Papillary Thyroid Cancer Patients Who Do Not Undergo Postoperative Radioiodine Remnant Ablation: Is There a Role for Serum Thyroglobulin Measurement?

Durante, Cosimo; Montesano, Teresa; Attard, Marco; Torlontano, Massimo; Monzani, Fabio; Costante, Giuseppe; Meringolo, Domenico; Ferdeghini, M; Tumino, Dario; Lamartina, Livia; Paciaroni, Alessandro; Massa, Michela; Giacomelli, Luciano; Ronga, Giuseppe; Filetti, Sébastiano

doi:10.1210/jc.2012-1123

Cited by 142 publications

(77 citation statements)

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“…First, we could not validate the dynamic risk stratification system for patients who did not receive RAI ablation therapy or for those who did lobectomy because we only included patients who underwent total or near total thyroidectomy followed by RAI ablation, which made relatively homogenous characteristics and less confounding factors for analysis. A recent study suggested that the serum Tg level may also be useful during the follow-up period and it can predict outcomes for patients who did not receive RAI ablation therapy (27). In this regard, further studies are required to validate whether the dynamic risk stratification system could be useful for patients who did not receive RAI ablation therapy.…”

Section: Discussionmentioning

confidence: 99%

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Jeon

Kim

Park

et al. 2014

European Journal of Endocrinology

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Objective: A new risk stratification system was proposed to estimate the risk of recurrence in patients with differentiated thyroid carcinoma (DTC) using the response to initial therapy. Here, we describe the modified dynamic risk stratification system, which takes into consideration the status of serum anti-Tg antibody (TgAb), and validate this system for assessing the risk of recurrence in patients with DTC. Patients and methods: Patients who underwent total thyroidectomy with radioiodine remnant ablation due to DTC between 2000 and 2005 were included. We classified patients into four groups based on the response to the initial therapy ('excellent', 'acceptable', 'biochemical incomplete', and 'structural incomplete' response). Results: The median follow-up period of 715 patients with DTC was 8 years. The response to initial therapy was an important risk predictor for recurrent/persistent DTC. The relative risks (95% CI) of recurrence were 16.5 (6.3-43.0) in the 'acceptable response ' group, 41.3 (15.4-110.8) in the 'biochemical incomplete response' group, and 281.2 (112.9-700.5) in the 'structural incomplete response' group compared with the 'excellent response' group (P!0.001, P!0.001, and P!0.001 respectively). The disease-free survival rate of the 'excellent response' group to initial therapy was 98.3% whereas that of the 'structural incomplete response' group was only 6.8%. Conclusions: Our study validates the usefulness of the modified dynamic risk stratification system including the status of serum TgAb for predicting recurrent/persistent disease in patients with DTC. Personalized risk assessment using the response to initial therapy could be useful for the follow-up and management of patients with DTC.

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Section: Discussionmentioning

confidence: 99%

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Jeon

Kim

Park

et al. 2014

European Journal of Endocrinology

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“…This assessment is based on well-known TNM staging which determines mortality but not the risk of recurrence. Recurrence assessment system proposed by 2015 ATA guideline (Tables 2 and 3) is a reliable predictor for the course of diferentiated thyroid carcinoma treated with thyroidectomy alone or radioiodine remnant ablation [57][58][59][60].…”

Section: Managementmentioning

confidence: 99%

Thyroid Cancers: Considerations, Classifications, and Managements

Khosravi¹,

Kouhi²,

Saeedi³

et al. 2017

Diagnosis and Management of Head and Neck Cancer

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Rapidly increasing trend of thyroid cancer incidence has turned this disease into a global concern. An estimated number of 64,300 new cases of thyroid cancer occurred in men and women in 2016, which represents 3.8% of all new cancer cases of USA (htps://seer. cancer.gov/statfacts/html/thyro.html). Thus, there is a high possibility for every physician to encounter a case of thyroid cancer during his/her professional lifetime. In this chapter, we clariied epidemiology, diferent categories, and new approaches toward diagnosis and management of thyroid cancer.Keywords: thyroid cancer, epidemiology, diferentiated thyroid cancer, undiferentiated thyroid cancer, thyroid nodule Detailed epidemiology of thyroid cancerAs the most common endocrine cancer and ifth most common cancer in women, thyroid cancer includes approximately 1-1.5% of all new cases of cancer diagnosed annually in the USA based on previous data [1][2][3]. Thyroid cancer is more prevalent among women and those with positive family history of thyroid disease. Some prior studies have reported a worldwide increasing trend for thyroid cancer incidence in recent decades [4]. Annual percent change (APC) is a commonly used indicator for the assessment of changes in incidence. Based on US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, it has been reported 2.4% from 1980 to 1997 and 6.6% from 1997 to 2009 in both genders for thyroid cancer (data available at htp://seer.cancer.gov/statfacts/html/thyro.html).© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.According to [2009][2010][2011][2012][2013] data, the rate of new cases of thyroid cancer was 13.9 per 100,000 men and women per year (Figure 1). Table 1 summarizes number of new cases per 100,000 persons by race/ethnicity and sex. A recently published study on adolescent cancer incidence during 1975-2012 has reported a 2.12% increase for females and 1.59% for males between 15 and 19 years of age [5]. However, there is a study indicating that thyroid cancer incidence trend has slowed following release of American Thyroid Association (ATA) guideline in 2009 [6, 7]. It has been reported that overall thyroid cancer incidence had an increasing trend about 8% per year from 2000 to 2009. But APC showed a deceleration about 3% in men and 2.8% in women, which was conined to tumors less than 2.9 cm of size for women [7].Also, thyroid cancer-related mortality was estimated to consist 0.3% of all cancer-related deaths in 2016. A 5-year survival rate of 98.1% has been reported for thyroid cancer. Despite increasing trend of incidence, thyroid cancer mortality has a relatively stable rate about 0.5 cases per 100,000 persons both from 1973 to 2002 and 2009 to 2013 [8, 9].In conclusion, it seems that thyroid cancer has been following an ...

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“…To our knowledge, this is so far the first prospective study that evaluated tumor recurrence in patients with low postoperative nonstimulated Tg, who were not treated with 131 I because of this result. In contrast to previous studies in which most of the patients had microcarcinoma restricted to the thyroid (Durante et al 2012, Ibrahimpasic et al 2012, Nascimento et al 2013, Angell et al 2014, these patients and those with noninvasive E-FVPTC (Rosario et al 2014a) were excluded from the present study because there is consensus that ablation of thyroid remnant is not necessary in these cases. More than half the patients were older than 45 years and 2 of 3 had a multicentric tumor O1 and %4 cm (T1b-2Nx), tumor O4 cm or with extrathyroid invasion (T3Nx), or clinically apparent LN metastases (T1-2cN1).…”

Section: Discussionmentioning

confidence: 99%

“…The rate of recurrence was the same (3 of 112 (2.6%)) when only patients with a follow-up time O5 years were analyzed. Even when measured with a second-generation assay, undetectable or low nonstimulated Tg can be achieved in many patients submitted to total thyroidectomy (Giovanella et al 2008, Durante et al 2012, Nascimento et al 2013, Angell et al 2014, Rosario et al 2015a, 2015b. In these patients, two studies have shown that RxWBS did not reveal persistent disease in any case after the administration of 131 I (1.1-3.7 GBq; Giovanella et al 2008, Rosario et al 2015a.…”

Section: Discussionmentioning

confidence: 99%

“…Little information is available about the rate of recurrence in patients with low nonstimulated Tg after thyroidectomy who were not submitted to radioiodine therapy because of this finding. In previous studies involving patients not submitted to ablation of thyroid remnant who had low postoperative nonstimulated Tg, most patients had microcarcinoma restricted to the thyroid and nonaggressive histology (Durante et al 2012, Ibrahimpasic et al 2012, Nascimento et al 2013, Angell et al 2014; thus, there was already no indication for radioiodine. Taking together all of these series, the number of patients with non-T1aN0-NxM0 stage tumors was only about 100 (Durante et al 2012, Ibrahimpasic et al 2012, Nascimento et al 2013, Angell et al 2014.…”

Section: Introductionmentioning

confidence: 99%

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Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

Mourão¹,

Rosário²,

Calsolari³

2015

Endocrine-Related Cancer

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This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) who had low nonstimulated thyroglobulin (Tg), measured with a second-generation assay, after total thyroidectomy and who were not submitted to ablation with 131 I. The objective was to define whether low postoperative nonstimulated Tg can be used as a criterion to spare patients with PTC from therapy with 131 I. This was a prospective study including 222 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroid invasion (pT4), aggressive histology, extensive lymph node (LN) involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg!0.3 ng/ml, negative antithyroglobulin antibodies (TgAb) and neck ultrasonography (US) showing no anomalies. Because of this finding, the patients were not submitted to ablation with 131 I. The time of follow-up ranged from 15 to 102 months (median 62 months). Of the 222 patients, 217 (97.7%) continued to have nonstimulated Tg !0.3 ng/ml and negative US. Tg was undetectable in the last assessment in 185 of these patients and detectable in 32. Five patients (2.2%) exhibited an increase in Tg, and LN metastases were detected in 4 (structural recurrence). One patient progressed to an increase in Tg, but disease was not detected by the imaging methods (biochemical recurrence). The results obtained here suggest that patients with PTC who have low nonstimulated Tg (measured with a second-generation assay and in the absence of TgAb) and negative neck US after thyroidectomy do not require ablation with 131 I.

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Long-Term Surveillance of Papillary Thyroid Cancer Patients Who Do Not Undergo Postoperative Radioiodine Remnant Ablation: Is There a Role for Serum Thyroglobulin Measurement?

Abstract: In most RRA-negative patients, postoperative serum Tg values spontaneously drop to undetectable levels within 5-7 yr after thyroidectomy. Thus, in later phases, Tg assays may be a valuable tool for follow-up even in patients who do not undergo RRA.

Cited by 142 publications

References 20 publications

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Thyroid Cancers: Considerations, Classifications, and Managements

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

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