Journal Article

Time to Separate Persistent From Recurrent Differentiated Thyroid Cancer: Different Conditions With Different Outcomes

Pellegriti, Gabriella, Vigneri, Riccardo, Belfiore, Antonino, Sapuppo, Giulia, Tavarelli, Martina

2019

Overview

Abstract Context Differentiated thyroid cancer (DTC) has an excellent prognosis, but up to 20% of patients with DTC have disease events after initial treatment, indistinctly defined as persistent/recurrent disease. Objective To evaluate the prevalence and outcome of “recurrent” disease (relapse after being 12 months disease-free) compared with “persistent” disease (present ab initio since diagnosis). Design Retrospective analysis of persistent/recurrent disease in patients with DTC (1990 to 2016) with 6.5 years of mean follow-up. Setting Tertiary referral center for thyroid cancer. Patients In total, 4292 patients all underwent surgery ± 131I treatment of DTC. Main Outcome Measures DTC cure of disease persistence or recurrence. Results A total of 639 of 4292 (14.9%) patients had disease events after initial treatment, most (498/639, 78%) with persistent disease and 141 (22%) with recurrent disease. Relative to patients with recurrent disease, patients with persistent disease were significantly older (mean age 46.9 vs 45.7 years) and with a lower female to male ratio (1.9/1 vs 4.8/1). Moreover, in this group, structured disease was more frequent (65.7% vs 41.1%), and more important, distant metastases were significantly more frequent (38.4% vs 17.0%). At multivariate analysis, male sex (OR = 1.7), age (OR = 1.02), follicular histotype (OR = 1.5), T status (T3; OR = 3), and N status (N1b; OR = 7.7) were independently associated with persistent disease. Only the N status was associated with recurrent disease (N1b; OR = 2.5). Conclusions In patients with DTC not cured after initial treatment, persistent disease is more common and has a worse outcome than recurrent disease. Postoperative status evaluated during first-year follow-up may have important clinical implications for planning tailored treatment strategies and long-term follow-up procedures. Prevalence and outcome of recurrent (after 1 year) vs persistent disease (since diagnosis) were studied. In patients not cured after initial therapy, persistence was more common, with a worse outcome.

• Publisher: Endocrine Society,Copyright Oxford University Press,Oxford University Press
• Subject: Adenocarcinoma, Follicular - pathology / Adenocarcinoma, Follicular - secondary / Adenocarcinoma, Follicular - therapy / Adult / Cancer metastasis / Cancer recurrence / Carcinoma, Papillary - pathology / Carcinoma, Papillary - secondary / Carcinoma, Papillary - therapy / Care and treatment / Cell Differentiation / Development and progression / Female / Follow-Up Studies / Health aspects / Humans / Lymphatic Metastasis / Male / Metastases / Middle Aged / Multivariate analysis / Neoplasm Recurrence, Local - etiology / Neoplasm Staging / Neoplasm, Residual / Patients / Prognosis / Recurrence (Disease) / Retrospective Studies / Risk Factors / Surgery / Thyroid cancer / Thyroid diseases / Thyroid Neoplasms - pathology / Thyroid Neoplasms - therapy / Treatment Outcome / Triiodothyronine