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Prognostic Factors Associated with the Survival of Patients Developing Loco-Regional Recurrences of Differentiated Thyroid Carcinomas

Service de Médecine Nucléaire (A.R., M.-O.B., A.A., L.L.), Unité de Recherche en Imagerie Médicale Quantitative Institut National de la Santé et de la Recherche Médicale Unité 494 (G.H., M.-O.B., A.A., L.L.), Unité de Recherche en Epidémiologie et Sciences de l’Information Institut National de la Santé et de la Recherche Médicale Unité 444 (P.-Y.B.), Service de Chirurgie Générale et Digestive (F.M.), Service d’Anatomie et de Cytologie Pathologiques (G.M., C.H.); Groupe Hospitalier et Faculté de Médecine Pitié-Salpêtrière (A.R., G.H., M.-O.B., F.M., G.M., C.H., A.A., L.L.), 75651 Paris, France; and Faculté de Médecine Saint Antoine (P.-Y.B.), 75571 Paris, France

Address all correspondence and requests for reprints to: Dr. Laurence Leenhardt, Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière, 83 Bd de l’Hôpital, 75651 Paris Cedex 13, France. E-mail: laurence.leenhardt{at}psl.ap-hop-paris.fr.

To estimate survival of patients with loco-regional recurrences (LRRs) of differentiated thyroid carcinomas (DTCs) and to identify factors associated with survival after LRRs, we analyzed retrospective data of the 172 patients treated and followed up in our institution from 1958 to 2000 who had developed LRRs (6% of DTC patients). Ultrasound, when used, picked up 95% of the recurrences. Survival was estimated with the method of Kaplan-Meier, and associated prognostic features were studied in univariate and multivariate Cox model-based analyses. Cumulated survival rates 10 yr after LRRs were 49.1, 89.3, and 32.1% for all patients, patients aged less than 45 yr, and older patients, respectively. Multivariate analysis identified three features related to initial tumor (age 45 yr, follicular histology, presence of thyroid capsular effraction), the absence of radioiodine ablation of thyroid remnants after initial surgery (10% of patients did not receive radioiodine), the presence of distant metastases before LRR diagnosis, and two features related to the LRRs (no radioiodine uptake and thyroid bed location) as significantly associated with a reduced survival. Our results underline the seriousness of LRRs of DTCs and could be used to identify patients who should benefit from a closer follow-up and especially reactive therapeutic intervention.

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