Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients

Detalhes bibliográficos
Autor(a) principal: Carvalho,Andre de Ywata
Data de Publicação: 2021
Outros Autores: Kohler,Hugo Fontan, Gomes,Camila Couto, Vartanian,José Guilherme, Kowalski,Luiz Paulo
Tipo de documento: Artigo
Idioma: eng
Título da fonte: International Archives of Otorhinolaryngology
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1809-48642021000400585
Resumo: Abstract Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial. Objective To identify the clinical and pathological factors predictive of tumor recurrence. Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the AmericanThyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence. Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95% CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95% CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients. Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age <55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.
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spelling Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patientsthyroidpapillary microcarcinomarecurrenceprognosisrisk stratificationAbstract Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial. Objective To identify the clinical and pathological factors predictive of tumor recurrence. Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the AmericanThyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence. Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95% CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95% CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients. Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age <55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.Fundação Otorrinolaringologia2021-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1809-48642021000400585International Archives of Otorhinolaryngology v.25 n.4 2021reponame:International Archives of Otorhinolaryngologyinstname:Fundação Otorrinolaringologia (FORL)instacron:FORL10.1055/s-0040-1722253info:eu-repo/semantics/openAccessCarvalho,Andre de YwataKohler,Hugo FontanGomes,Camila CoutoVartanian,José GuilhermeKowalski,Luiz Pauloeng2021-12-15T00:00:00Zoai:scielo:S1809-48642021000400585Revistahttps://www.scielo.br/j/iao/https://old.scielo.br/oai/scielo-oai.php||iaorl@iaorl.org||archives@internationalarchivesent.org||arquivos@forl.org.br1809-48641809-4864opendoar:2021-12-15T00:00International Archives of Otorhinolaryngology - Fundação Otorrinolaringologia (FORL)false
dc.title.none.fl_str_mv Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
title Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
spellingShingle Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
Carvalho,Andre de Ywata
thyroid
papillary microcarcinoma
recurrence
prognosis
risk stratification
title_short Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
title_full Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
title_fullStr Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
title_full_unstemmed Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
title_sort Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients
author Carvalho,Andre de Ywata
author_facet Carvalho,Andre de Ywata
Kohler,Hugo Fontan
Gomes,Camila Couto
Vartanian,José Guilherme
Kowalski,Luiz Paulo
author_role author
author2 Kohler,Hugo Fontan
Gomes,Camila Couto
Vartanian,José Guilherme
Kowalski,Luiz Paulo
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Carvalho,Andre de Ywata
Kohler,Hugo Fontan
Gomes,Camila Couto
Vartanian,José Guilherme
Kowalski,Luiz Paulo
dc.subject.por.fl_str_mv thyroid
papillary microcarcinoma
recurrence
prognosis
risk stratification
topic thyroid
papillary microcarcinoma
recurrence
prognosis
risk stratification
description Abstract Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial. Objective To identify the clinical and pathological factors predictive of tumor recurrence. Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the AmericanThyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence. Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95% CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95% CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients. Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age <55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.
publishDate 2021
dc.date.none.fl_str_mv 2021-12-01
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dc.publisher.none.fl_str_mv Fundação Otorrinolaringologia
publisher.none.fl_str_mv Fundação Otorrinolaringologia
dc.source.none.fl_str_mv International Archives of Otorhinolaryngology v.25 n.4 2021
reponame:International Archives of Otorhinolaryngology
instname:Fundação Otorrinolaringologia (FORL)
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instname_str Fundação Otorrinolaringologia (FORL)
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reponame_str International Archives of Otorhinolaryngology
collection International Archives of Otorhinolaryngology
repository.name.fl_str_mv International Archives of Otorhinolaryngology - Fundação Otorrinolaringologia (FORL)
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