Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Abstract

Objective: Lymph node metastases (LNM) are frequent in patients with papillary thyroid cancer (PTC). The risk of persistent disease (PD) and tumor recurrence (TR) is increased when factors for poor prognosis other than LNM exist, when LNM are numerous, large, detected by preoperative ultrasonography (US), or exhibit extranodal extension. This study evaluated the risk of PD and TR in patients with LNM not exhibiting these characteristics. Subjects and methods: Eighty-six patients with 5 or fewer LNM detected during intraoperative inspection, but not by preoperative US, who had no other factors for poor prognosis [tumors > 4 cm, extensive extrathyroid invasion, vascular invasion, aggressive histological subtype, distant metastases, incomplete tumor resection], were studied. All patients underwent total thyroidectomy followed by radioiodine ablation. PD was defined as metastases on initial post-therapy whole-body scans (RxWBS) or detected by imaging methods up to 12 months after ablation. TR was defined as structural disease diagnosed more than one year after ablation in patients without PD. Results: PD was diagnosed in 3/86 patients (3.5%). TR was observed in 2/83 patients (2.5%) after 62 months of follow-up. There was no case of death due to the disease. A correlation was observed between pre-ablation Tg and PD or TR [1/48 (2%) with Tg ≤ 2 ng/mL versus 2/22 (9%) with Tg > 2 ≤ 10 ng/mL versus 2/7 (28.5%) with Tg ≥ 10 ng/ml)]. It is noteworthy that 38 patients had up to 3 positive LN and pre-ablation Tg ≤ 2 ng/ml, and none of them had PD or TR. Conclusions: The frequency of PD and TR was low in patients with PTC with 5 or fewer LNM and without other factors for poor prognosis. Low postoperative stimulated Tg was predictive of the absence of PD and TR in these patients. Arch Endocrinol Metab. 2015;59(4):285-91

E-Cadherin gene expression in oral cancer: Clinical and prospective data

“…The average follow-up was 43.02 ± 13.48 months, with a minimum of 21 months and a maximum of 65 months. Persistence was diagnosed in patients who showed tumoral activity based on imaging studies after a 9 to 12 month period after the conclusion of therapy, according to the criteria previously described by DeSouza et al (27). Additionally, recurrence of the disease was defined as, despite there being a period of time with eradication of clinical and imaging manifestations of disease, also known as disease-free period or disease-free interval, the reappearance of cancer, whether in the location of the original tumor (local recurrence), in regional lymph nodes or in adjacent tissues (regional recurrence), or if it had disseminated to any other body part (distant recurrence) (28).…”

The evolving field of thyroid cancer: refinement of old and creation of new paradigms

“…On one side of the spectrum, Furtado and cols. demonstrate the low incidence of persistent (3.5%) and recurrent disease (2.5%) in patients with papillary thyroid cancer with less than 5 lymph nodes detected only at the operative procedure and without other poor prognostic factors (2). As expected, these patients have low risk of recurrence raising the question whether radioactive iodine treatment provides any benefit, a situation in which the disease could be less harmful than the treatment.…”

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation

“…The need for radioiodine is controversial in the remaining patients. In these individuals, when postoperative-stimulated thyroglobulin (Tg) is low (in the absence of anti-Tg antibodies (TgAb)), post-therapy whole-body scanning (RxWBS) rarely detects persistent disease , Rosario et al 2011, Furtado et al 2015 and the risk of recurrence is very low (about 1% in 5 years), even without the administration of radioiodine (Vaisman et al 2010, Rosario et al 2012, Orlov et al 2015. In fact, many authors recommend low postoperative-stimulated Tg as a criterion to spare these patients from therapy with 131 I (Vaisman et al 2010, Rosario et al 2011, Schlumberger et al 2011, Orlov et al 2015.…”