Prognostic Factors for Excellent Response to Initial Therapy in Patients With Papillary Thyroid Cancer From a Prospective Multicenter Study

Abstract

Prognostic factors for excellent response (ER) to initial therapy in patients with papillary thyroid cancer (PTC) have not been determined. In this study, we investigated the response to initial therapy in PTC patients and independent prognostic factors for ER in a prospective multicenter study in China. A total of 506 PTC patients from nine centers in China were enrolled in this study, all of whom underwent total or near total thyroidectomy with lymph node dissection and subsequent radioiodine therapy. Univariate and multivariable logistic regression analyses were carried out to determine the independent prognostic factors for ER. The optimal cutoff value of the number of metastatic lymph nodes for predicting ER was determined by the receiver operating characteristic curve. A total of 139 patients (27.5%) achieved ER after initial therapy. Extrathyroidal extension, the number of metastatic lymph nodes, and preablative-stimulated thyroglobulin (Ps-Tg) were independent risk factors for ER for the entire population. In a subgroup analysis, extrathyroidal extension and Ps-Tg were independent risk factors for ER in pathological N1a patients, while the number of metastatic lymph nodes and Ps-Tg were independent risk factors for ER in pathological N1b patients. The appropriate cutoff values of the number of metastatic lymph nodes in predicting ER were 5 and 13 for the entire population and pathological N1b PTC patients, respectively. PTC patients with more metastatic lymph nodes were more likely to fail to achieve ER. Extrathyroidal extension, the number of metastatic lymph nodes, and Ps-Tg were important prognostic factors for ER after initial therapy in PTC patients.

Predictors of response to Radioactive Iodine Therapy in Intermediate and high risk patients with papillary thyroid carcinoma

“…Moreover, gender was not a predictor of response in our study. In line with our results, previous studies also found no significant association between gender and response to the treatment [ 10 , 23 ] or recurrent disease [ 25 ]. However, an increase in the risk of persistent disease is reported in male patients with PTC [ 26 ].…”

“…Previous studies demonstrated that preablation serum Tg has a high predictive value for the prediction of recurrence and/or treatment failure [ 3 , 10 ]; however, the optimal cut-off value is different among the studies [ 7 , 11 – 14 ]. It is worth mentioning that other factors might affect serum Tg.…”

“…It has been reported that the presence of more than five metastatic cervical lymph nodes following prophylactic lymph node dissection is an independent risk factor for treatment failure [ 10 ], or recurrent disease [ 22 , 27 ]. However, these reports mostly included low-risk patients with stage 1 or those with lateral lymph node involvement [ 11 , 26 ].…”

“…This might explain the lack of association between lymph node involvement and response to treatment. Multifocality is also considered as a risk factor for treatment failure [ 1 ], or recurrence [ 28 , 29 ] of DTC, however, its prognostic significance has not been proven in the other studies [ 10 , 12 , and 23 ]. It should be mentioned that some studies highlighted the size of the lesion, namely greater than one cm, as a prognostic factor [ 27 , 28 ].…”

Impact factors of benefiting from initial 131I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response

“…Our study of 548 patients demonstrated gender, serum ps-Tg and interval time were independent predictors of a complete short-term response to initial 131 I ablation. This paper indicated female patients were more likely to benefit, which is consistent with the results of previous studies [1,2,17–19]. However, it should be noted that the incidence of thyroid cancer in male patients has increased faster than that in female patients, and the mortality has increased year by year.…”