Endocrinol Metab.  2015 Dec;30(4):543-550. 10.3803/EnM.2015.30.4.543.

Risk Factors for Recurrence in Filipinos with Well-Differentiated Thyroid Cancer

• Lo TE
• Canto AU
• Maningat P

• KMID: 2169664
• DOI: http://doi.org/10.3803/EnM.2015.30.4.543

Abstract

BACKGROUND
The incidence of well-differentiated thyroid cancer (WDTC) has increased in recent years. Despite its excellent prognosis, increasing morbidity from recurrent diseases continues to affect long-term outcomes. Among at-risk populations, Filipinos have the highest incidence of thyroid cancer worldwide, characterized by a highly aggressive and recurrent form of disease. Here, we sought to identify risk factors associated with disease recurrence among Filipinos with WDTC.
METHODS
This retrospective cohort study examined 723 patients diagnosed with WDTC seen at Philippine General Hospital. Affected individuals were classified based on the presence or absence of disease recurrence. Multivariate logistic regression analyses were used to determine significant predictors of recurrence.
RESULTS
Multiple risk factors, including age >45 years (odds ratio [OR], 1.44), multifocality of cancer (OR, 1.43), nodal involvement (OR, 4.0), and distant metastases at presentation (OR, 2.78), were significantly associated with a recurrence of papillary thyroid cancer (PTC). In contrast, follicular variant histology (OR, 0.60) and postsurgical radioactive iodine therapy (OR, 0.31) were protective for PTC recurrence. Distant metastases at presentation (OR, 19.4) and postsurgical radioactive iodine therapy (OR, 0.41) were associated with follicular thyroid cancer (FTC) recurrence.
CONCLUSION
Lymph node metastases at presentation was the strongest predictor of recurrence in PTC, whereas distant metastases at presentation was the strongest for FTC recurrence. Among Filipinos, stratification of WDTC patients based on recurrence risk factors identified in this study will be helpful in guiding the intensity of treatment strategies and long-term thyroid cancer surveillance.

Keyword

Thyroid neoplasms; Thyroid cancer, follicular; Thyroid cancer, papillary

MeSH Terms

Cohort Studies
Hospitals, General
Humans
Incidence
Iodine
Logistic Models
Lymph Nodes
Neoplasm Metastasis
Prognosis
Recurrence*
Retrospective Studies
Risk Factors*
Thyroid Gland*
Thyroid Neoplasms*
Iodine

Figure

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  Fig. 1 Kaplan-Meier disease-free estimate curves of significant factors for papillary thyroid cancer recurrence. (A) Multifocality. (B) Lymph node metastases at presentation. (C) Distant metastases at presentation. (D) Age >45. (E) Histologic type. (F) Postsurgical radioactive iodine (RAI) ablation.

• 

  Fig. 2 Kaplan-Meier disease-free estimate curves of significant factors for follicular thyroid cancer recurrence. (A) Distant metastases at presentation. (B) Postsurgical radioactive iodine (RAI) ablation.

Reference

1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006; 295:2164–2167.

2. Magarey MJ, Freeman JL. Recurrent well-differentiated thyroid carcinoma. Oral Oncol. 2013; 49:689–694.

3. Nixon IJ, Ganly I, Palmer FL, Whitcher MM, Patel SG, Tuttle RM, et al. Disease-related death in patients who were considered free of macroscopic disease after initial treatment of well-differentiated thyroid carcinoma. Thyroid. 2011; 21:501–504.

4. Coburn M, Teates D, Wanebo HJ. Recurrent thyroid cancer. Role of surgery versus radioactive iodine (I131). Ann Surg. 1994; 219:587–593.

5. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–1214.

6. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97:418–428.

7. Baek SK, Jung KY, Kang SM, Kwon SY, Woo JS, Cho SH, et al. Clinical risk factors associated with cervical lymph node recurrence in papillary thyroid carcinoma. Thyroid. 2010; 20:147–152.

8. Kolonel LN. Cancer incidence among Filipinos in Hawaii and the Philippines. Natl Cancer Inst Monogr. 1985; 69:93–98.

9. Goodman MT, Yoshizawa CN, Kolonel LN. Descriptive epidemiology of thyroid cancer in Hawaii. Cancer. 1988; 61:1272–1281.

10. Haselkorn T, Bernstein L, Preston-Martin S, Cozen W, Mack WJ. Descriptive epidemiology of thyroid cancer in Los Angeles County, 1972-1995. Cancer Causes Control. 2000; 11:163–170.

11. Kus LH, Shah M, Eski S, Walfish PG, Freeman JL. Thyroid cancer outcomes in Filipino patients. Arch Otolaryngol Head Neck Surg. 2010; 136:138–142.

12. Clark JR, Eski SJ, Freeman JL. Risk of malignancy in Filipinos with thyroid nodules: a matched pair analysis. Head Neck. 2006; 28:427–431.

13. Patron V, Hitier M, Bedfert C, Le Clech G, Jegoux F. Occult lymph node metastases increase locoregional recurrence in differentiated thyroid carcinoma. Ann Otol Rhinol Laryngol. 2012; 121:283–290.

14. Ito Y, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Miyauchi A. Clinical outcomes of patients with papillary thyroid carcinoma after the detection of distant recurrence. World J Surg. 2010; 34:2333–2337.

15. Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004; 130:819–824.

16. Kim SJ, Park SY, Lee YJ, Lee EK, Kim SK, Kim TH, et al. Risk factors for recurrence after therapeutic lateral neck dissection for primary papillary thyroid cancer. Ann Surg Oncol. 2014; 21:1884–1890.

17. Ito Y, Kudo T, Kobayashi K, Miya A, Ichihara K, Miyauchi A. Prognostic factors for recurrence of papillary thyroid carcinoma in the lymph nodes, lung, and bone: analysis of 5,768 patients with average 10-year follow-up. World J Surg. 2012; 36:1274–1278.

18. Waseem Z, Palme CE, Walfish P, Freeman JL. Prognostic implications of site of recurrence in patients with recurrent well-differentiated thyroid cancer. J Otolaryngol. 2004; 33:339–344.

19. Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg. 2007; 245:366–378.

20. LiVolsi VA. Papillary carcinoma tall cell variant (TCV): a review. Endocr Pathol. 2010; 21:12–15.

21. Yu XM, Schneider DF, Leverson G, Chen H, Sippel RS. Follicular variant of papillary thyroid carcinoma is a unique clinical entity: a population-based study of 10,740 cases. Thyroid. 2013; 23:1263–1268.

22. Lin HW, Bhattacharyya N. Clinical behavior of follicular variant of papillary thyroid carcinoma: presentation and survival. Laryngoscope. 2010; 120:712–716.

23. Tsang RW, Brierley JD, Simpson WJ, Panzarella T, Gospodarowicz MK, Sutcliffe SB. The effects of surgery, radioiodine, and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma. Cancer. 1998; 82:375–388.

24. McGriff NJ, Csako G, Gourgiotis L, Lori CG, Pucino F, Sarlis NJ. Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med. 2002; 34:554–564.