Radioactive iodine ablation may not decrease the risk of recurrence in intermediate-risk papillary thyroid carcinoma

Kim, Seo Ki; Woo, Jung-Woo; Lee, Jun Ho; Park, Inhye; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo

doi:10.1530/erc-15-0572

Cited by 33 publications

(32 citation statements)

References 43 publications

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“…Unfortunately, this study did not analyze diseasespecific survival (DSS), which might be more valuable than overall survival, because the overall survival might be affected by age and comorbidities. In contrast, other investigations did not show any benefit of RAI therapy, including a recent large-sample report from a single center in which RAI therapy did not reduce the risk of loco-regional recurrence in patients with intermediate-risk PTC, even in patients with aggressive characteristics such as BRAF positivity, multifocality, extrathyroidal extension, and regional lymph node metastases [17].…”

Section: Introductionmentioning

confidence: 81%

“…In a retrospective study, Chow SM et al [20] analyzed the subgroup of 352 patients with microscopic extrathyroidal extension and found that RAI treatment can significantly reduce the risk of recurrence. However, in a single institution retrospective studies from South Korea analyzing data from a cohort of 8297 intermediate-risk PTC patients, RAI treatment was not significantly related to the risk of loco-regional recurrence after adjusting for clinicopathological characteristics [17]. Another study from Korea also indicated that RAI treatment did not decrease recurrence in intermediate-risk patients with…”

Section: Plos Onementioning

confidence: 94%

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The benefits of radioactive iodine ablation for patients with intermediate-risk papillary thyroid cancer

Wang

Zhu

et al. 2020

PLoS ONE

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Background The beneficial effects of radioactive iodine (RAI) ablation for intermediate-risk papillary thyroid cancer (PTC) patients are still controversial. Materials and methods To determine the impact of RAI therapy on disease-specific survival (DSS) in patients with intermediate-risk PTC, we retrospectively analyzed the data of 23107 intermediate-risk PTC patients who underwent primary thyroidectomy with or without RAI in the Surveillance, Epidemiology, and End Results (SEER) database. Results RAI therapy was significantly associated with improved DSS (adjusted HR = 0.65, P = 0.017) in intermediate-risk PTC patients after multivariate adjusting for clinicopathological characteristics. However, subgroup analyses demonstrated that RAI ablation was only associated with improved DSS in patients with male gender (adjusted HR = 0.47, P = 0.005), age � 45 years (adjusted HR = 0.34, P < 0.001) and tumor size > 20 mm (adjusted HR = 0.58, P = 0.007). Conclusion RAI decision-making should be considered on an individual basis rather than "one size fits all" in intermediate-risk PTC patients; only patients with male gender, age � 45 years, and tumor size > 20 mm may benefit from RAI therapy.

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Section: Introductionmentioning

confidence: 81%

Section: Plos Onementioning

confidence: 94%

The benefits of radioactive iodine ablation for patients with intermediate-risk papillary thyroid cancer

Wang

Zhu

et al. 2020

PLoS ONE

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“…The medical decision process for referral to treatment with RAI should therefore incorporate a careful analysis of the benefits and risks for this therapy, particularly in the case of younger patients. Moreover, increasing reports published recently have demonstrated that RAI could not decrease disease-free survival and disease-specific mortality in PTMC patients, even in the intermediate-risk DTC [ 10 , 11 ]. Thus, we performed this retrospective study to evaluate the function of RAI in PTMC with LLNM (belong to intermediated-risk DTC) and explore the prognostic factors for recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, in recent years, several studies suggested that RAI did not prevent recurrences in patients with PTMC. In Hye Jeong Kim’s study, we have huge concerns about the selection bias since the RAI (−) group was only 30 cases compared with the RAI (+) group of 450 patients in the subgroup of intermediated risk [ 10 ]. Furthermore, 74% cases in RAI (−) group were TNM stage I while only 47% in RAI (+) group.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of differentiated thyroid carcinoma with LLNM, RAI was recommended by ATA because of the higher risk of persistent or recurrent disease, especially with the presence of extra-nodal extension or clinically positive or increasing number of macroscopic lymph nodes [ 5 ]. However, increasing studies demonstrated that the vast majority of PTMC were inert carcinomas, so aggressive surgery and RAI ablation were considered as overtreatments because they could not improve the recurrence and outcome [ 9 , 10 ]. Moreover, such systematic review and meta-analysis of the effectiveness of RAI therapy for PTMC have been performed and conclude that for PTMC patients already treated by total thyroidectomy (TT), RAI ablation may not be helpful to decrease the incidence of thyroid cancer-related mortality or the 10-year recurrence of PTMC.…”

Section: Introductionmentioning

confidence: 99%

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Radioactive Iodine Ablation Decrease Recurrences in Papillary Thyroid Microcarcinoma with Lateral Lymph Node Metastasis in Chinese Patients

et al. 2017

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IntroductionWe aimed to carry out a retrospective study from a single institution to determine whether radioactive iodine (RAI) ablation decreases the risk of recurrence of papillary thyroid microcarcinoma (PTMC) patients that presented with lateral lymph node metastasis (LLNM).MethodsWe retrospectively analyzed a total of 6361 consecutive PTMC patients who initially underwent surgery for the treatment of thyroid carcinoma at the First Hospital of Jilin University, between January 2005 and February 2015. Altogether, 137 patients with PTMC with LLNM have been enrolled in our study.ResultsThe disease-free survival period was significantly shorter for the RAI (−) patients than for the RAI (+) patients (p = 0.0074 by the log-rank test). The disease-free survival rates at 5 and 10 years were 93.02 and 87.5%, respectively, in the RAI (−) group and 100 and 96.81%, respectively, in the RAI (+) group. CLNM ratio and LLNM ratio were factors identified for multivariate analysis by Cox’s proportional hazards method yielding risk ratios of 7.281 [CI 1.804–17.554; p = 0.010] and 1.157 [CI 1.0125–9.381; p = 0.048] in the RAI (−) group.ConclusionTaken together, RAI may be beneficial for PTMC with LLNM, especially when CLNM ratio or LLNM ratio was greater than 0.5.

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Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma

Kim

Kwon

Moon

2021

JAMA Otolaryngol Head Neck Surg

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hyroid cancer is the ninth most frequent cancer worldwide, and its incidence has risen dramatically. 1,2 There were 567 233 patients with newly diagnosed thyroid cancer in 2018, representing 3.1% of all cancer cases worldwide. Papillary thyroid carcinoma (PTC) comprises more than 80% of all thyroid cancers, and is usually associated with an excellent prognosis; 3 however, up to 30% of patients experience significant disease progression, including regional recurrences and distant metastases. [4][5][6] Researchers have tried to identify the patients at high-risk from among the population with favorable outcomes; 7-9 clinicopathological factors, including tumor size, extrathyroidal extension, lymph node metastasis, and multifocality, have been thoroughly evaluated in an effort to predict recurrence and mortality.Multifocality in thyroid cancer is defined as the simultaneous presence of more than 1 tumor focus within the thyroid gland. 10 Multifocality in PTC occurred in 18% to 87% of the cases in the literature. 10,11 Several studies have demonstrated that multifocality is associated with high-risk features of PTC, including aggressive histologic subtype, extrathyroidal extension, lymph node involvement, distant metastasis, and recurrences. 12-14 Some researchers have further demonstrated that multifocal PTCs could decrease overall and cancer-specific survival. 11,15 Other researchers have indicated that patients with multifocal diseases showed a similar clinical course or comparable recurrence rates as those with unifocal disease. [16][17][18] These conflicting results indicate a need IMPORTANCE Multifocality is common in papillary thyroid carcinoma (PTC), but it is unclear whether multifocal tumors are associated with tumor recurrence or cancer-specific survival. OBJECTIVE To compare tumor recurrence rates in patients with multifocal vs unifocal PTCs. DATA SOURCES We searched PubMed, SCOPUS, Web of Science Core Collection, and Cochrane Database of Systematic Reviews for pertinent studies published in English from inception to June 30, 2020. STUDY SELECTION The search strategy yielded 26 studies that compared tumor recurrence in patients with multifocal vs unifocal PTC. DATA EXTRACTION AND SYNTHESIS Data was extracted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Characteristics of study populations and hazard ratio (HR) of multifocality were independently extracted by 2 investigators. MAIN OUTCOMES AND MEASURESThe primary outcome was tumor recurrence and the secondary outcome was cancer-specific survival. Subgroup analysis of the primary outcome was based on primary tumor size, number of tumor foci, and patient age. RESULTS Among 26 studies with a total of 33 976 patients, recurrence rates were significantly higher in patients with multifocal PTC than in those with unifocal PTC (pooled HR, 1.81; 95% CI, 1.52-2.14). Cancer-specific survival was comparable between the groups (HR, 1.19; 95% CI, 0.85-1.68). In subgroup analyses, the HRs of m...

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Radioactive iodine ablation may not decrease the risk of recurrence in intermediate-risk papillary thyroid carcinoma

Cited by 33 publications

References 43 publications

The benefits of radioactive iodine ablation for patients with intermediate-risk papillary thyroid cancer

The benefits of radioactive iodine ablation for patients with intermediate-risk papillary thyroid cancer

Radioactive Iodine Ablation Decrease Recurrences in Papillary Thyroid Microcarcinoma with Lateral Lymph Node Metastasis in Chinese Patients

Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma

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