Effect of reoperation on outcomes in papillary thyroid cancer

Young, Shuenn‐Tsong; Harari, Avital; Smooke-Praw, Stephanie; Ituarte, Philip H.G.; Yeh, Michael W.

doi:10.1016/j.surg.2013.06.043

Cited by 42 publications

(37 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lastly, one may argue that follow‐up was limited, thereby underestimating the true risk of recurrence. However, the previous literature now reports that recurrence is most likely in the first 2–3 years following treatment . Therefore, with a follow‐up of 53 months, the majority of recurrences would have occurred in our patient cohort.…”

Section: Discussionmentioning

confidence: 73%

Role of RAI in the management of incidental N1a disease in papillary thyroid cancer

Wang

Palmer

Migliacci

et al. 2015

Clinical Endocrinology

View full text Add to dashboard Cite

Background Following total thyroidectomy (TT) for papillary thyroid cancer (PTC), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes (LNs) with occult metastases. These cN0pN1a patients often receive radioactive iodine (RAI) therapy for this indication alone. The aim of this study was to determine the central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment. Methods An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. 232 pT1-3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LNs on pathology. Patients with other indications for RAI, such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan-Meier method was used to determine central neck LN recurrence free survival (RFS). Results The median age of the cohort was 40 years (range 17–83). The median follow up was 53 months (range 1–211). The median number of positive LNs removed and maximum LN diameter was 1 (range 1–8) and 5mm (range 1–16mm), respectively. 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion (p=0.01), LNs >2mm (p=0.07) and >2 positive nodes (p=0.06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5 year central neck LN RFS to those treated with RAI; 96.2% vs. 94.6% respectively (p=0.92). Conclusion There is no difference in the 5 year central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.

show abstract

Section: Discussionmentioning

confidence: 73%

Role of RAI in the management of incidental N1a disease in papillary thyroid cancer

Wang

Palmer

Migliacci

et al. 2015

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…For example, a large Californian cancer registry database of 11,986 patients has demonstrated that 84% of recurrences occur within the first 2 years of initial operation. 24 This may also contribute to the relatively low recurrence rate of only 1.2% in this cohort of patients. Furthermore, it is also possible that we may have underreported nodal recurrence in the period before 2000, when the use of ultrasonography and serial Tg monitoring was not routine.…”

Section: Discussionmentioning

confidence: 82%

Comparable outcomes for patients with pT1a and pT1b differentiated thyroid cancer: Is there a need for change in the AJCC classification system?

Wang

Nixon

Palmer

et al. 2014

Surgery

View full text Add to dashboard Cite

“…First, the literature suggests that the majority of recurrences in PTC occur within the first 2 to 3 years after the diagnosis. 6 Second, the costs associated with surveillance for thyroid cancer are mostly incurred immediately after surgery. Unless the recurrence event developed within 3 years of surgery, all patients completed 3 years of follow-up.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of papillary thyroid cancer surveillance

Wang

Roman

Migliacci

et al. 2015

Cancer

View full text Add to dashboard Cite

BACKGROUND The recent overdiagnosis of subclinical, low-risk papillary thyroid cancer (PTC) coincides with a growing national interest in cost-effective health care practices. The aim of this study was to measure the relative cost-effectiveness of disease surveillance of low-risk PTC patients versus intermediate- and high-risk patients in accordance with American Thyroid Association risk categories. METHODS Two thousand nine hundred thirty-two patients who underwent thyroidectomy for differentiated thyroid cancer between 2000 and 2010 were identified from the institutional database; 1845 patients were excluded because they had non-PTC cancer, underwent less than total thyroidectomy, had a secondary cancer, or had <36 months of follow-up. In total, 1087 were included for analysis. The numbers of postoperative blood tests, imaging scans and biopsies, clinician office visits, and recurrence events were recorded for the first 36 months of follow-up. Costs of surveillance were determined with the Physician Fee Schedule and Clinical Lab Fee Schedule of the Centers for Medicare and Medicaid Services. RESULTS The median age was 44 years (range, 7–83 years). In the first 36 months after thyroidectomy, there were 3, 44, and 22 recurrences (0.8%, 7.8%, and 13.4%) in the low-, intermediate-, and high-risk categories, respectively. The cost of surveillance for each recurrence detected was US $147,819, US $22,434, and US $20,680, respectively. CONCLUSIONS The cost to detect a recurrence in a low-risk patient is more than 6 and 7 times greater than the cost for intermediate- and high-risk PTC patients. It is difficult to justify this allocation of resources to the surveillance of low-risk patients. Surveillance strategies for the low-risk group should, therefore, be restructured.

show abstract

Effect of reoperation on outcomes in papillary thyroid cancer

Cited by 42 publications

References 24 publications

Role of RAI in the management of incidental N1a disease in papillary thyroid cancer

Role of RAI in the management of incidental N1a disease in papillary thyroid cancer

Comparable outcomes for patients with pT1a and pT1b differentiated thyroid cancer: Is there a need for change in the AJCC classification system?

Cost‐effectiveness analysis of papillary thyroid cancer surveillance

Contact Info

Product

Resources

About