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Differentiated thyroid cancer recurrence rates low after initial therapy
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Patients with differentiated thyroid cancer who were disease-free after their initial treatment were likely to stay disease-free at long-term follow-up, according to recent study findings published in Thyroid.
Further, the patients may require less intensive follow-up, according to the researchers.
Rafael Scheffel
Rafael Scheffel, MD, PhD, and Ana Luiza Maia, MD, PhD, of the Hospital de Clínicas de Porto Alegre in Brazil, and colleagues evaluated 786 patients (81.6% women) with differentiated thyroid cancer (DTC) who attended the thyroid outpatient clinic at the Hospital de Clínicas de Porto Alegre from 2000 to 2014. Researchers sought to determine the overall recurrence rates and factors related to persistent disease among the cohort.
Data on disease status after initial therapy was available for 548 patients: 65.1% had a disease-free status, and 34.9% had persistent disease. Of those with persistent disease, the most common was structure disease (n = 101; 62 with cervical metastasis, 39 with distant metastasis) followed by biochemical disease (n = 90).
A median 4-year follow-up was conducted for the 548 patients with available data, and most who were considered disease-free remained so (97.2%). Of the patients with biochemical disease, 15.6% were considered disease-free at follow-up, with 57% not receiving additional treatment. Biochemical disease remained in 77.8%, and at follow-up, 6.6% had cervical structural disease.
Ana Luiza Maia
Of those with structural disease, 10.9% were considered disease-free after additional treatment, 14.9% had biochemical disease and 75.2% still had structural disease at follow-up.
“The majority of patients who were defined as disease free after the initial treatment remained disease free after a long follow-up and might not require active, life-long surveillance,” the researchers wrote. “We believe our data, derived from a cohort of DTC patients from a South American referral center, add to the evidences to review the current protocol of follow-up for patients with no structural or biochemical signs of persistent disease after the initial evaluation.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Kathleen Hands, MD, FACE, ECNU
A necessary study showing need for de-intensification of follow-up for an indolent cancer, namely papillary thyroid carcinoma. This is a good heterogeneous population of patients showing similar demographics to most practices with 6% distant metastases and approximately 28% positive lymph node disease, 87% papillary thyroid carcinoma. Of the 357 patient, 65% were considered disease free and 35% considered to have persistent disease. This is a rather large number of persistent disease given the heterogeneous population with 62% of patients in stage I. With expert surgical care, high-resolution ultrasound for preoperative assessment, persistent rates in the United States tend to be far lower. Independent prognostic factors for persistent disease is consistent with the American Thyroid Association guidelines showing male patients, lateral lymph node involvement and distant metastasis being independent predictors for persistent disease.
Shortcomings [of the study]: in patients with recurrent disease, it is not clarified whether these are patients who had follicular thyroid carcinoma, more aggressive cell types, or initial negative whole-body scan for those patients who failed to follow-up with initial whole-body scan.
The American Joint Committee on Cancer staging system does take into consideration risk assessment, and 2014 risk assessment should include number and size of metastases in metastatic lymph nodes as well as cancer type (follicular thyroid cancer) and aggressive (tall cell) type lesions. These facts would help determine which patient should be followed more closely. Overall, with low-risk features, stable neck ultrasound and thyroglobulin should be used to gauge appropriate follow-up, especially in low-risk patients with thyroglobulin less than 2 ng/dL.
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