Prognostic factors and treatment responses among patients with gross residual disease in differentiated thyroid cancer
Copyright © 2024, the Chinese Medical Association..
BACKGROUND: Various postoperative staging systems were developed to assess the outcome of differentiated thyroid cancer (DTC) from initial risk after surgery to dynamic changing prognosis during follow-up. The objective of our retrospective cohort study was to identify risk factors contributing to macroscopic positive surgical margin (R2 resection) and parameters in discriminating the treatment responses and prognosis among R2 patients.
METHODS: In total, 242 DTC patients with extrathyroidal extension who underwent a thyroidectomy at Kaohsiung Chang Gung Memorial Hospital between January 2013 and July 2018, were included. The patients were grouped according to the presence or absence of gross residual disease (R2). The R2 patients were further classified into two categories according to their treatment response into excellent and non-excellent groups. The parameters and treatment outcomes were compared between these groups.
RESULTS: The mean follow-up time was 45.3 months. 207 (85.5%) patients had either surgery-free or microscopic margins (R0/R1), while 35 (14.5%) had R2 resection. In the R2 group (n = 35), 15 (42.9%) patients achieved an excellent response, while 20 (57.1%) achieved a non-excellent response. Statistically significant differences were observed in the extent of neck dissection, TSH-Tg level, post-RAI Tg level, nodal status, and recurrence between the two groups. The Kaplan-Meier curves for 5-year local and distant recurrence-free survival (LRFS and DRFS) of R0/R1 vs. R2 patients were 90.0% vs. 66.3%, and 98.4% vs.90.7% respectively, (p <0.001). Among the R2 patients, the excellent responders had a higher LRFS than non-excellent responders (93.3% vs. 45.1%, p=0.008).
CONCLUSION: There are significant disparities in RFS among R2 patients with different treatment responses. The nodal status of PTC and thyroglobulin level after thyroidectomy and RAI were factors contributing to difference in their treatment responses.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of the Chinese Medical Association : JCMA - (2024) vom: 16. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Chiew, Yvonne Ee Wern [VerfasserIn] |
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Date Revised 16.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1097/JCMA.0000000000001095 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM371149479 |
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| 100 | 1 | |a Chiew, Yvonne Ee Wern |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic factors and treatment responses among patients with gross residual disease in differentiated thyroid cancer |
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| 520 | |a Copyright © 2024, the Chinese Medical Association. | ||
| 520 | |a BACKGROUND: Various postoperative staging systems were developed to assess the outcome of differentiated thyroid cancer (DTC) from initial risk after surgery to dynamic changing prognosis during follow-up. The objective of our retrospective cohort study was to identify risk factors contributing to macroscopic positive surgical margin (R2 resection) and parameters in discriminating the treatment responses and prognosis among R2 patients | ||
| 520 | |a METHODS: In total, 242 DTC patients with extrathyroidal extension who underwent a thyroidectomy at Kaohsiung Chang Gung Memorial Hospital between January 2013 and July 2018, were included. The patients were grouped according to the presence or absence of gross residual disease (R2). The R2 patients were further classified into two categories according to their treatment response into excellent and non-excellent groups. The parameters and treatment outcomes were compared between these groups | ||
| 520 | |a RESULTS: The mean follow-up time was 45.3 months. 207 (85.5%) patients had either surgery-free or microscopic margins (R0/R1), while 35 (14.5%) had R2 resection. In the R2 group (n = 35), 15 (42.9%) patients achieved an excellent response, while 20 (57.1%) achieved a non-excellent response. Statistically significant differences were observed in the extent of neck dissection, TSH-Tg level, post-RAI Tg level, nodal status, and recurrence between the two groups. The Kaplan-Meier curves for 5-year local and distant recurrence-free survival (LRFS and DRFS) of R0/R1 vs. R2 patients were 90.0% vs. 66.3%, and 98.4% vs.90.7% respectively, (p <0.001). Among the R2 patients, the excellent responders had a higher LRFS than non-excellent responders (93.3% vs. 45.1%, p=0.008) | ||
| 520 | |a CONCLUSION: There are significant disparities in RFS among R2 patients with different treatment responses. The nodal status of PTC and thyroglobulin level after thyroidectomy and RAI were factors contributing to difference in their treatment responses | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Yang, Yi-Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Chi, Shun-Yu |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Yi-Chia |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Yen-Hsiang |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Lay-San |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Wen-Chieh |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Yung-Nien |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Shu-Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Chou, Chen-Kai |e verfasserin |4 aut | |
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