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Patient age influences recurrence of papillary thyroid carcinoma
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Recurrences after remission of papillary thyroid cancer in adults vary by time course, patient age and area of the recurrence, according to findings published in Thyroid.
Jae Hoon Chung, MD, PhD, of the division of endocrinology and metabolism at Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea, and colleagues evaluated data from the institutional thyroid cancer database on 2,250 adults (mean age, 48.43 years) with papillary thyroid carcinoma larger than 1 cm who achieved complete remission after total thyroidectomy and/or radioactive iodine treatment to determine the timing and patterns of recurrence. Follow-up was a mean of 8.1 years.
Overall, the 5-year disease-free survival rate was 97.8%, and the 10-year rate was 95.6%; 97% of participants had no recurrence after the initial remission (no evidence of disease group), and 3% experienced recurrence during the follow-up period.
Three percent of participants developed structural recurrences during follow-up, including lymph node recurrences (n = 53), local soft tissue recurrences (n = 11) and distant recurrences (n = 4). Researchers evaluated the participants with local soft tissue recurrences and distant recurrences together because of the low numbers.
Compared with the no evidence of disease group, the lymph node recurrences group showed significant differences in unfavorable histology, large tumor size and central and lateral lymph node metastases, and the combined local soft tissue recurrences and distant recurrences group showed significant differences for older age, proportion of initial central neck dissection and tumor size.
Tumor size, multifocal tumor, unfavorable histology and central and lateral lymph node metastases were identified as significant risk factors for lymph node recurrences in the unadjusted analysis. Multifocal tumor and central and lateral lymph node metastases were also independent risk factors for lymph node recurrences after adjustment for other variables. In the unadjusted analysis, age, initial central neck dissection and tumor size were significantly associated with local soft tissue recurrences and distant recurrences. Initial neck dissection, tumor size and lateral lymph node metastasis were also independently associated with local soft tissue recurrences and distant recurrences after adjustment for other variables (P < .05).
The risks for local soft tissue recurrences and distant recurrences were significantly increased when the tumor size was greater than 2 cm compared with smaller sizes (HR = 5.87; 95% CI, 1.4-24.65).
The recurrence rate for lymph node recurrences peaked at 20 to 39 years, whereas it increased with age in local soft tissue recurrences and distant recurrences. After remission, recurrences were found at a mean of 3.86 years for lymph node recurrences and 4.38 years for local soft tissue recurrences and distant recurrences.
“The pattern of recurrence showed a different incidence according to time course and patient age,” the researchers wrote. “This finding has an important impact on prognosis. Furthermore, each recurrence pattern was associated with a different spectrum of risk factors. Understanding the timing and patterns of recurrence may lead to more effective adjuvant treatment and improve long-term follow-up strategies.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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