Research
Factors determining the persistence or recurrence of well-differentiated thyroid cancer treated by thyroidectomy and/or radioiodine in the Boston, Massachusetts area: A retrospective chart review
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* Corresponding author: Angela M Leung angela.leung@bmc.org
1 Section of Endocrinology, Diabetes, and Nutrition; Boston University School of Medicine; Boston, MA; USA
2 Division of Graduate Medical Sciences; Boston University Medical Center; Boston, MA: USA
3 Endocrinology; Harvard Vanguard Medical Associates; Boston, MA; USA
4 Internal Medicine; Harvard Vanguard Medical Associates; Boston, MA; USA
5 Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine; Beth Israel Deaconess Medical Center; Boston, MA; USA
Thyroid Research 2011, 4:9 doi:10.1186/1756-6614-4-9
Published: 15 April 2011Abstract
Objective
To assess predictors of well-differentiated thyroid cancer (WDTC) persistence/recurrence.
Design
This was a retrospective chart review of thyroid carcinoma patients seen 1979-2007 in a Boston, Massachusetts-area multispecialty group. Of 1,025 patients, 431 met eligibility criteria. Cox proportional hazards models were used to assess predictors (gender, age, ethnicity, tumor size, surgical histology) of WDTC persistence/recurrence (elevated thyroglobulin levels with negative thyroglobulin-antibodies; or positive imaging). Local extension of disease and lymph node involvement could not be assessed.
Results
Mean age at initial surgery (n = 431, 74% women, 79% Caucasian) was 45.8 ± 13.5(SD) years. Mean tumor (papillary, 91%; follicular, 5%; Hurthle cell, 2%; ≥1 type, 2%) size was 2.5 ± 1.6(SD) cm. Most tumors were unifocal (57%) and ≥1 cm (89%). Over 2,600 person-years of follow-up, persistence/recurrence occurred in 52 patients (12%) 4.3 years (median; range 0.2-23.2 years) after surgery. Gender, ethnicity, tumor size, multifocality, and histology were not predictive of persistence/recurrence, while older age was predictive in some models.
Conclusions
In WDTC patients treated by total and near total thyroidectomy and radioiodine and analyzed without consideration of local, locoregional, and distant extent of disease, neither size of tumor nor male gender contribute to disease persistence/recurrence. Age at diagnosis seems to have some positive prognostic value even if only patients older than 21 years at diagnosis are considered. Due to the rare occurrence of follicular (also oxyphilic) histotype, this conclusion refers mainly to patients with papillary thyroid cancer.