Postablation Stimulated Thyroglobulin Level is an Important Predictor of Biochemical Complete Remission after Reoperative Cervical Neck Dissection in Persistent/Recurrent Papillary Thyroid Carcinoma

Abstract

BackgroundThe efficacy of reoperative cervical neck dissection (RND) in achieving biochemical complete remission (BCR) (or postreoperation stimulated thyroglobulin [sTg] of <0.5 ng/mL) remains unclear in persistent/recurrent papillary thyroid carcinoma (PTC). We hypothesized that lower postablation sTg levels would indicate a higher rate of BCR after RND. Our study examined the association between postablation sTg and BCR after one or more RNDs.MethodsOf 199 patients who underwent RND, 81 patients were eligible. The postablation sTg levels (≤2 and >2 ng/mL) were correlated with the postreoperation sTg levels after RNDs. Patients’ clinicopathological characteristics, operative findings, and subsequent RNDs were compared between those with BCR after RNDs and those without.ResultsThose with postablation sTg levels of ≤2 ng/mL had significantly higher BCR rate after the first RND (77.8 vs. 5.6 %, p < 0.001), overall BCR after one or more RNDs (77.8 vs. 9.3 %, p < 0.001), and better 5-year recurrence-free survival after the first RND (80.0 vs. 60.1 %, p = 0.049) than those with postablation sTg levels of >2 ng/mL. Overall BCR gradually decreased after each subsequent RND. Postablation sTg significantly correlated with postreoperation sTg (ρ = 0.509, p < 0.001). After adjusting for the number of metastatic lymph nodes excised at first RND and presence of extranodal extension, postablation sTg of ≤ 0.2 ng/mL was the only independent factor for BCR after one or more RNDs (odds ratio 37.0, 95 % confidence interval 5.68–250.0, p = 0.001).ConclusionsOnly a third of patients who underwent one or more RNDs for persistent/recurrent PTC had BCR afterward. Postablation sTg level was an independent factor for BCR. Completeness of the initial operation is important for the subsequent success of RND.

New Molecular Targeted Therapy and Redifferentiation Therapy for Radioiodine-Refractory Advanced Papillary Thyroid Carcinoma: Literature Review

“…Despite its relatively good prognosis with a 10-year cancer-specific survival above 90%, locoregional recurrences and distant metastasis do occur not infrequently [2]. Of the 5–20% patients who may develop locoregional recurrences, approximately two-thirds of these recurrences involved the cervical lymph nodes.…”

“…In terms of treating locoregional recurrence, a formal selective neck dissection for lymph node recurrence is usually preferred but at times when certain compartments has been previously dissected, a focused neck dissection or completion compartmental neck dissection might be preferred [2]. However, despite the best surgical effort, only approximately one-third of patients would become biochemically cured of the disease (i.e., athyroglobulinemia) and therefore, the American Thyroid Association (ATA) only recommended surgical removal of clinically significant metastatic lymph nodes to prevent future locoregional complications [2, 5, 6].…”

“…However, despite the best surgical effort, only approximately one-third of patients would become biochemically cured of the disease (i.e., athyroglobulinemia) and therefore, the American Thyroid Association (ATA) only recommended surgical removal of clinically significant metastatic lymph nodes to prevent future locoregional complications [2, 5, 6]. Other options include percutaneous ethanol injection and radiofrequency ablation (RFA) as their efficacy have been shown in several studies [7–9].…”

Prognostic Factors Affecting Disease-Specific Survival in Patients with Recurrent and/or Metastatic Differentiated Thyroid Carcinoma Detected by Positron Emission Tomography/Computed Tomography

“…Selective neck dissection for lymph node recurrence is usually the preferred PROGNOSTIC FACTORS IN METASTATIC/RECURRENT THYROID CANCER procedure in terms of treating locoregional recurrence. When certain compartments have been previously dissected, a focused neck dissection or completion compartmental neck dissection might be considered (16,17). However, the benefit of surgically removing small-volume metastatic lymph nodes still remains controversial (18).…”

“…However, the benefit of surgically removing small-volume metastatic lymph nodes still remains controversial (18). Despite the best surgical efforts, recent studies report that biochemical remission can be reached only in one-third of patients (16). Furthermore, to prevent future locoregional complications, the American Thyroid Association guidelines recommend surgical removal of only clinically significant metastatic lymph nodes (18)(19)(20).…”