Predictors of recurrence after total thyroidectomy plus neck dissection and radioactive iodine ablation for high‐risk papillary thyroid carcinoma

Kim, Yonghan; Roh, Jong–Lyel; Song, Dae Jin; Cho, Kyung‐Ja; Choi, Seung‐Ho; Nam, Soon Yuhl; Kim, Sang Yoon

doi:10.1002/jso.26090

Cited by 10 publications

(7 citation statements)

References 33 publications

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“…We observed a significant influence of age on having an excellent response after initial therapy, developing NED, recurrence, and DSM for either PTC or FTC. Kim et al showed no influence of age on recurrence using 55 years age cutoff in patients with PTC (15); the recurrence rate in their patients was with 16.5% in line with ours (13.9%). On the other hand, Trimboli et al showed a significant influence of age on relapse using an age cutoff of 55 years of age in patients with high-risk DTC (14).…”

Section: Discussionsupporting

confidence: 85%

“…Therefore, the ATA Risk Stratification System may further improve should age be incorporated as an additional risk factor.American Joint Committee on Cancer (UICC/AJCC) Tumor, Node, Metastasis (TNM) staging system (11,12,13), age was not incorporated into the classification of patients into different prognostic groups. Recently, three studies investigated the influence of age on recurrence and disease outcome in patients with DTC (9,14,15), including those with ATA high-risk DTC. Subsequently, it was shown that the 2015 ATA Risk Stratification System…”

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confidence: 99%

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The influence of age on disease outcome in 2015 ATA high-risk differentiated thyroid cancer patients

Velsen¹,

Peeters²,

Stegenga³

et al. 2021

European Journal of Endocrinology

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Objective Recent research suggests that the addition of age improves the 2015 American Thyroid Association (ATA) Risk Stratification System for differentiated thyroid cancer (DTC). The aim of our study was to investigate the influence of age on disease outcome in ATA High Risk patients with a focus on differences between patients with papillary (PTC) and follicular thyroid cancer (FTC). Methods We retrospectively studied adult patients with High Risk DTC from a Dutch university hospital. Logistic regression and Cox proportional hazards models were used to estimate the effects of age (at diagnosis) and several age cutoffs (per five years increment between 20 and 80 years) on (i) response to therapy, (ii) developing no evidence of disease (NED), (iii) recurrence, and (iv) disease specific mortality (DSM). Results We included 236 ATA High Risk patients (32% FTC) with a median follow-up of 6 years. Age, either continuously or dichotomously, had a significant influence on having an excellent response after initial therapy, developing NED, recurrence, and DSM for PTC and FTC. For FTC, an age cutoff of 65 or 70 years showed the best statistical model performance, while this was 50 or 60 years for PTC. Conclusions In a population of patients with High Risk DTC, older age has a significant negative influence on disease outcomes. Slightly different optimal age cutoffs were identified for the different outcomes, and these cutoffs differed between PTC and FTC. Therefore, the ATA Risk Stratification System may further improve should age be incorporated as an additional risk factor.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

The influence of age on disease outcome in 2015 ATA high-risk differentiated thyroid cancer patients

Velsen¹,

Peeters²,

Stegenga³

et al. 2021

European Journal of Endocrinology

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“…A number of prognostic factors, including age, sex, histology, tumor size, vascular invasion, lymph node metastasis and extrathyroidal extension (ETE) have been identified as predictors of recurrence and patient outcome (16)(17)(18)(19)(20). However, there has been considerable controversy regarding microscopic ETE (m-ETE) (as determined histologically using microscopic evaluation) and its prognostic significance, as well as its association with recurrence (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Microscopic Extrathyroidal Extension Results in Increased Rate of Tumor Recurrence and Is an Independent Predictor of Patient’s Outcome in Middle Eastern Papillary Thyroid Carcinoma

et al. 2021

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BackgroundPapillary Thyroid Cancer (PTC) is the most common endocrine malignancy, with recurrence rate as high as 30%. A great deal of controversy surrounds the significance of microscopic extrathyroidal extension (m-ETE) as a prognostic factor. The most recent edition (8th) of American Joint Committee on Cancer (AJCC) staging system has removed m-ETE from the definition of pT3, which suggests that m-ETE may lack prognostic impact in PTC patients. Moreover, data about m-ETE prevalence and clinical impact on Middle Eastern PTC remains unknown. We therefore investigate the prevalence of m-ETE and its clinico-pathological correlation and prognostic impact in Middle Eastern PTC. We also compared the AJCC 7th and 8th staging systems and their prognostic performance.MethodsPTCs from 1430 consecutive adult (> 18 years) patients from single tertiary care hospital were included in this study. A retrospective analysis of PTC patients’ survival and recurrence were compared between AJCC 8th and AJCC 7th staging systems using Proportion of Variation Explained (PVE) and Harrell’s C-index.ResultsMedian follow up of the study cohort was 9.3 years. 31.2% (446/1430) of patients had m-ETE. In the overall cohort, m-ETE was associated with multiple adverse features such as older age (p < 0.0001), male sex (p = 0.0245), tall cell variant (p < 0.0001), bilateral tumors (p < 0.0001), multifocality (p < 0.0001), lymphovascular invasion (p < 0.0001), lymph node metastasis (p < 0.0001), distant metastasis (p = 0.0166), tumor recurrence (p < 0.0001), radioactive iodine refractoriness (p < 0.0001), BRAF mutation (p < 0.0001) and reduced recurrence-free survival (RFS; HR = 1.75; 95% CI = 1.30 – 2.35; p < 0.0001) irrespective of tumor size. Of the 611 patients with T3 disease based on AJCC 7th edition, 359 (58.8%) were down-staged in AJCC 8th edition classification. Overall, the prognostic performance of AJCC 8th edition was inferior to AJCC 7th on the basis of lower PVE (3.04% vs. 3.73%) and lower C-index (0.40 vs. 0.48).ConclusionsIn Middle Eastern PTC, m-ETE is significantly associated with compromised survival and acts as an independent predictor of RFS. Given these findings, m-ETE should be included in the thyroid cancer treatment guidelines.

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“…Several studies agree that LVI has a positive correlation with LNMs ( 19 – 22 ), and a negative impact on outcomes of patient ( 6 , 23 , 24 ), although single studies report no significant association with response to therapy ( 39 ). In this study, the positive correlation with LNMs can be confirmed.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

et al. 2022

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PurposeIt is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards.MethodsPatients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed.ResultsA total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively.ConclusionIn routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.

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Predictors of recurrence after total thyroidectomy plus neck dissection and radioactive iodine ablation for high‐risk papillary thyroid carcinoma

Cited by 10 publications

References 33 publications

The influence of age on disease outcome in 2015 ATA high-risk differentiated thyroid cancer patients

The influence of age on disease outcome in 2015 ATA high-risk differentiated thyroid cancer patients

Microscopic Extrathyroidal Extension Results in Increased Rate of Tumor Recurrence and Is an Independent Predictor of Patient’s Outcome in Middle Eastern Papillary Thyroid Carcinoma

Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer

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