Hosu Kim1,2, Tae Hyuk Kim1, Jun-Ho Choe3, Jung-Han Kim3, Jee Soo Kim3, Young Lyun Oh4, Soo Yeon Hahn5, Jung Hee Shin5, Sang Ah Chi6, Sin-Ho Jung7, Young Nam Kim1, Hye In Kim1, Sun Wook Kim1, Jae Hoon Chung1. 1. 1 Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea. 2. 2 Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital , Changwon. Korea. 3. 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea. 4. 4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea. 5. 5 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea. 6. 6 Department of Statics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea. 7. 7 Department of Biostatistics and Bioinformatics, Duke University , Durham, North Carolina.
Abstract
BACKGROUND: Despite improvements in the surgical and medical treatment of papillary thyroid carcinoma (PTC), subsets of patients suffer from structural recurrence after initial treatment. This study evaluated the timing and patterns of recurrence in completely resected PTC patients. METHODS: A retrospective review of a prospectively maintained thyroid cancer database was performed. The timing and patterns of recurrence were reviewed in 2250 patients with PTC >1 cm who achieved complete remission after total thyroidectomy and/or radioactive iodine treatment. Univariate and multivariate analyses were performed to identify factors predictive of recurrence patterns. RESULTS: During 8.1 years of mean follow-up, 68 (3.0%) patients developed structural recurrences: 53 lymph node recurrences (LNR), 11 local soft tissue recurrences (LR), and four distant recurrences (DR). Two patients died of DR. Younger patients had a higher proportion of LNR, and older patients had a tendency toward LR/DR. LNR showed a peak incidence between one and three years after remission, but LR/DR showed a delayed peak incidence between two and four years. The factors that significantly increased the risk of LNR were multifocal tumor and lymph node metastasis (central/lateral). The factors that increased the risk of LR/DR were old age, large tumor size (>2 cm), and lateral lymph node metastasis. In addition, central neck dissection significantly reduced subsequent LR/DR. CONCLUSION: Patterns of recurrence after complete PTC resection are variable and associated with specific clinicopathologic factors. Understanding the timing and patterns of recurrence may lead to more effective adjuvant treatment and improved long-term follow-up strategies.
BACKGROUND: Despite improvements in the surgical and medical treatment of papillary thyroid carcinoma (PTC), subsets of patients suffer from structural recurrence after initial treatment. This study evaluated the timing and patterns of recurrence in completely resected PTC patients. METHODS: A retrospective review of a prospectively maintained thyroid cancer database was performed. The timing and patterns of recurrence were reviewed in 2250 patients with PTC >1 cm who achieved complete remission after total thyroidectomy and/or radioactive iodine treatment. Univariate and multivariate analyses were performed to identify factors predictive of recurrence patterns. RESULTS: During 8.1 years of mean follow-up, 68 (3.0%) patients developed structural recurrences: 53 lymph node recurrences (LNR), 11 local soft tissue recurrences (LR), and four distant recurrences (DR). Two patients died of DR. Younger patients had a higher proportion of LNR, and older patients had a tendency toward LR/DR. LNR showed a peak incidence between one and three years after remission, but LR/DR showed a delayed peak incidence between two and four years. The factors that significantly increased the risk of LNR were multifocal tumor and lymph node metastasis (central/lateral). The factors that increased the risk of LR/DR were old age, large tumor size (>2 cm), and lateral lymph node metastasis. In addition, central neck dissection significantly reduced subsequent LR/DR. CONCLUSION: Patterns of recurrence after complete PTC resection are variable and associated with specific clinicopathologic factors. Understanding the timing and patterns of recurrence may lead to more effective adjuvant treatment and improved long-term follow-up strategies.
Entities:
Keywords:
metastasis; papillary carcinoma; recurrence pattern; relapse; remission; thyroid cancer
Authors: Se Jin Cho; Chong Hyun Suh; Jung Hwan Baek; Sae Rom Chung; Young Jun Choi; Jeong Hyun Lee Journal: Eur Radiol Date: 2019-02-26 Impact factor: 5.315
Authors: Hosu Kim; Hye In Kim; Sun Wook Kim; Jaehoon Jung; Min Ji Jeon; Won Gu Kim; Tae Yong Kim; Hee Kyung Kim; Ho Cheol Kang; Ji Min Han; Yoon Young Cho; Tae Hyuk Kim; Jae Hoon Chung Journal: Endocrinol Metab (Seoul) Date: 2018-06
Authors: Hye In Kim; Jiyeon Hyeon; So Young Park; Hyeon Seon Ahn; Kyunga Kim; Ji Min Han; Ji Cheol Bae; Jung Hee Shin; Jee Soo Kim; Sun Wook Kim; Jae Hoon Chung; Tae Hyuk Kim; Young Lyun Oh Journal: Thyroid Date: 2019-05-30 Impact factor: 6.568