This Article Full Text Full Text (PDF) All Versions of this Article: 90/10/5723    most recent Author Manuscript (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leboulleux, S. Articles by Schlumberger, M. Search for Related Content PubMed PubMed Citation Articles by Leboulleux, S. Articles by Schlumberger, M. Related Collections Thyroid

Prognostic Factors for Persistent or Recurrent Disease of Papillary Thyroid Carcinoma with Neck Lymph Node Metastases and/or Tumor Extension beyond the Thyroid Capsule at Initial Diagnosis

Departments of Nuclear Medicine and Endocrine Tumors (S.L., E.B., M.S.), Institut National de la Santé et de la Recherche Médicale U605 (C.R.), Pathology (B.C.), Surgical Oncology (J.-P.T., D.M.H.), and Clinical Biology (J.-M.B.), Institut Gustave Roussy, 94805 Villejuif Cédex, France

Address all correspondence and requests for reprints to: Martin Schlumberger, M.D., Department of Nuclear Medicine and Endocrine Tumors, Institut Gustave Roussy, Rue Camille Desmoulins, 94805 Villejuif Cedex, France. E-mail:schlumbg{at}igr.fr.

Context: Reliable prognostic factors are needed in papillary thyroid cancer patients to adapt initial therapy and follow-up schemes to the risks of persistent and recurrent disease.

Objective and Settings: To evaluate the respective prognostic impact of the extent of lymph node (LN) involvement and tumor extension beyond the thyroid capsule, we studied a group of 148 consecutive papillary thyroid cancer patients with LN metastases and/or extrathyroidal tumor extension. Initial treatment, performed at the Institut Gustave Roussy between 1987 and 1997, included in all patients a total thyroidectomy with central and ipsilateral en bloc neck dissection followed by radioactive iodine ablation.

Results: Uptake outside the thyroid bed, demonstrating persistent disease, was found on the postablation total body scan (TBS) in 22% of the patients. With a mean follow-up of 8 yr, eight patients (7%) with a normal postablation TBS experienced a recurrence. Ten-year disease-specific survival rate was 99% (confidence interval, 97–100%). Significant risk factors for persistent disease included the numbers of LN metastases (>10) and LN metastases with extracapsular extension (ECE-LN >3), tumor size (>4 cm), and LN metastases location (central). Significant risk factors for recurrent disease included the numbers of LN metastases (>10), ECE-LN (>3), and thyroglobulin level measured 6–12 months after initial treatment after T₄ withdrawal.

Conclusion: We highlight an excellent survival rate and suggest risk classifications of persistent and recurrent disease based on the numbers of LN metastases and ECE-LN, LN metastases location, tumor size, and thyroglobulin level.

This article has been cited by other articles:

				N. Wada, K. Masudo, H. Nakayama, N. Suganuma, K. Matsuzu, S. Hirakawa, Y. Rino, M. Masuda, and T. Imada Recommendation for Subclass Evaluation of TNM stage IVA Papillary Thyroid Carcinomas: T4aN1b Patients Are at Risk for Recurrence and Survival Ann. Surg. Oncol., May 1, 2008; 15(5): 1511 - 1517. [Abstract] [Full Text] [PDF]

				A. Toniato, I. Boschin, D. Casara, R. Mazzarotto, D. Rubello, and M. Pelizzo Papillary Thyroid Carcinoma: Factors Influencing Recurrence and Survival Ann. Surg. Oncol., May 1, 2008; 15(5): 1518 - 1522. [Abstract] [Full Text] [PDF]

				S. Bardet, E. Malville, J.-P. Rame, E. Babin, G. Samama, D. De Raucourt, J.-J. Michels, Y. Reznik, and M. Henry-Amar Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur. J. Endocrinol., April 1, 2008; 158(4): 551 - 560. [Abstract] [Full Text] [PDF]

				J. M. Cerutti, G. Oler, P. Michaluart Jr., R. Delcelo, R. M. Beaty, J. Shoemaker, and G. J. Riggins Molecular Profiling of Matched Samples Identifies Biomarkers of Papillary Thyroid Carcinoma Lymph Node Metastasis Cancer Res., August 15, 2007; 67(16): 7885 - 7892. [Abstract] [Full Text] [PDF]

				R. B T Verkooijen, D. Rietbergen, J. W Smit, J. A Romijn, and M. P M Stokkel A new functional parameter measured at the time of ablation that can be used to predict differentiated thyroid cancer recurrence during follow-up Eur. J. Endocrinol., January 1, 2007; 156(1): 41 - 47. [Abstract] [Full Text] [PDF]