Pathological N1b Node Metastasis Itself Can Be Still a Valid Prognostic Factor in PTC after High Dose RAI Therapy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives: The aim of this study was to determine whether pathologically proven central or lateral lymph node (LN) metastasis (pN1a or pN1b) could affect ablation success and recurrence after high-dose radioactive iodine (RAI) ablation. We also sought to identify the risk factors for long-term recurrence in patients with papillary thyroid carcinoma (PTC). Materials and Methods: A total of 277 patients with pN1 disease who had undergone high-dose RAI ablation (5.55 GBq) between 2000 and 2006 were included in this retrospective study. We compared the ablation success rate and the recurrence rate between patients with pN1a and pN1b disease. Univariate and multivariate analyses were performed to identify the risk factors for recurrence. Results: The median duration of follow-up was 10.2 years. The overall ablation success rate was 64%, and the ablation success rate in the pN1b group (49%) was lower than in the pN1a group (74%). The overall recurrence rate was 23%, and the recurrence rate in the pN1b group (30%) was higher than in pN1a group (18%). A higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were significant risk factors for recurrence by multivariate analysis. Conclusion: Patients with pN1b disease experienced a lower ablation success rate and a higher recurrence rate than patients with pN1a disease. However, a higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were stronger risk factors than the pathological N stage for long term recurrence in patients with node-positive PTC.
Abstract
Background and Objectives: The aim of this study was to determine whether pathologically proven central or lateral lymph node (LN) metastasis (pN1a or pN1b) could affect ablation success and recurrence after high-dose radioactive iodine (RAI) ablation. We also sought to identify the risk factors for long-term recurrence in patients with papillary thyroid carcinoma (PTC). Materials and Methods: A total of 277 patients with pN1 disease who had undergone high-dose RAI ablation (5.55 GBq) between 2000 and 2006 were included in this retrospective study. We compared the ablation success rate and the recurrence rate between patients with pN1a and pN1b disease. Univariate and multivariate analyses were performed to identify the risk factors for recurrence. Results: The median duration of follow-up was 10.2 years. The overall ablation success rate was 64%, and the ablation success rate in the pN1b group (49%) was lower than in the pN1a group (74%). The overall recurrence rate was 23%, and the recurrence rate in the pN1b group (30%) was higher than in pN1a group (18%). A higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were significant risk factors for recurrence by multivariate analysis. Conclusion: Patients with pN1b disease experienced a lower ablation success rate and a higher recurrence rate than patients with pN1a disease. However, a higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were stronger risk factors than the pathological N stage for long term recurrence in patients with node-positive PTC.
참고문헌 (20)
- Leboulleux S, "Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and", or tumor extension beyond the thyroid capsule at initial diagnosis, 2005, pp.90(10), 5723~5729
- Smith VA, "Cervical lymph node metastasis and papillary thyroid carcinoma: does the compartment involved affect survival? Experience from the SEER database", J Surg Oncol, 106(4), pp.357~362 (2012)
- The American Joint Committee on Cancer, "AJCC cancer staging manual", pp.87~96 (2010), Springer
- American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19(11), pp.1167~1214 (2009)
- Haugen BR, "2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer", Thyroid, 26(1), pp.1~133 (2016)
- Randolph GW, "The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension", Thyroid, 22(11), pp.1144~1152 (2012)
- Mazzaferri EL, "Thyroid remnant 131I ablation for papillary and follicular thyroid carcinoma", Thyroid, 7(2), pp.265~271 (1997)
- Castagna MG, "Post-surgical thyroid ablation with low or high radioiodine activities results in similar outcomes in intermediate risk differentiated thyroid cancer patients", Eur J Endocrinol, 169(1), pp.23~29 (2013)
- de Meer SG, "Not the number but the location of lymph nodes matters for recurrence rate and disease-free survival in patients with differentiated thyroid cancer", World J Surg, 36(6), pp.1262~1267 (2012)
- Mallick U, "Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer", N Engl J Med, 366(18), pp.1674~1685 (2012)
- Sabra MM, "Higher administered activities of radioactive iodine are associated with less structural persistent response in older, but not younger, papillary thyroid cancer patients with lateral neck lymph node metastases", Thyroid, 24(7), pp.1088~1095 (2014)
- Pacini F, "Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study", J Clin Endocrinol Metab, 91(3), pp.926~932 (2006)
- Jeon MJ, "Differentiating the location of cervical lymph node metastasis is very useful for estimating the risk of distant metastases in papillary thyroid carcinoma", Clin Endocrinol (Oxf), 81(4), pp.593~599 (2014)
- Nixon IJ, "The impact of nodal status on outcome in older patients with papillary thyroid cancer", Surgery, 156(1), pp.137~146 (2014)
- Beierwaltes WH, "An analysis of "ablation of thyroid remnants" with I-131 in 511 patients from 1947-1984: experience at University of Michigan", J Nucl Med, 25(12), pp.1287~1293 (1984)
- Schneider DF, "Lymph node ratio predicts recurrence in papillary thyroid cancer", Oncologist, 18(2), pp.157~162 (2013)
- Furtado Mde S, "Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis", Arch Endocrinol Metab, 59(4), pp.285~291 (2015)
- Schlumberger M, "Strategies of radioiodine ablation in patients with low-risk thyroid cancer", N Engl J Med, 366(18), pp.1663~1673 (2012)
- Sohn SY, "Association between excessive urinary iodine excretion and failure of radioactive iodine thyroid ablation in patients with papillary thyroid cancer", Thyroid, 23(6), pp.741~747 (2013)
- 하승균, "Clinical Outcome of Remnant Thyroid Ablation with Low Dose Radioiodine in Korean Patients with Low to Intermediate-risk Thyroid Cancer", Journal of Korean Medical Science, 30(7), pp.876~881 (2015), 대한의학회