EP110 – Factors associated with not achieving an excellent response in patients with differentiated thyroid cancer after initial therapy: A multicentric study in Colombia


    Dueñas, J.P.4; Torres, J.L.1; Marín Carrillo, L.F.2; Aristizábal, C.1; Aristizábal, N.1; Sylva, D.I.1; Ospina, D.C.3;  Natera, A.K.2; Gómez, C.M.2; Serrano Gómez, S.E.5, Wandurraga, E.A.3
    1 Faculty of Medicine, Pontifical Bolivarian University. Division of Endocrinology, Clinic of the Americas. Medellin, Colombia
    2 Faculty of Medicine, Pontifical Xaverian University. Division of Endocrinology, Hospital San Ignacio. Bogotá, Colombia
    3 Faculty of Medicine, Autonomous University of Bucaramanga UNAB. Division of Endocrinology, FOSCAL International Clinic, Bucaramanga, Colombia
    4 Division of Endocrine Surgery. Clinic of the Americas. Medellin, Colombia
    5 Division of Epidemiology. Autonomous University of Bucaramanga UNAB. Bucaramanga, Colombia


    Background/Purpose: The latest American Thyroid Association management guidelines for patients with differentiated thyroid cancer proposed a new terminology to classify response to therapy based on four categories. We aimed to know the initial response during the first 2 follow-up years and to establish the prognostic factors for not achieving an excellent response (ER).

    Methods: A retrospective descriptive study was conducted. Demographic, clinical and histopathological characteristics were collected from medical records of patients attended during 3 years in 3 hospitals of Colombia. The response to therapy was taken from the assessment performed between month 6 and 24 from initial therapy.

    Results: 489 patients were included. 411(84%) were treated with thyroidectomy and radioactive iodine. ER was found in 60.9% of patients, indeterminate response in 17.9%, biochemical incomplete response in 8.7% and structural incomplete response in 12.3%. Factors associated with not achieving an ER in the univariate analysis were the male sex, capsular / lymphovascular invasion, T (from TNM), extrathyroid extension, central and lateral metastatic lymph node involvement and extranodal extension. After a multivariate analysis, the total number of metastatic lymph nodes (OR 1.13 CI95%1.02-1.26, for each metastatic node p=0.013), preablative stimulated thyroglobulin ?10 ng/ml (OR 6.87 CI95%3.05-15.46), lymphovascular invasion (OR 3.19 CI95%1.42-7.17) and T3 (OR 3.21 CI95%1.27-8.07) and T4 (OR 1.05-14.50) were associated with not reaching an ER.

    Conclusions: The presence of lymphovascular invasion, T3 or T4 category, the increasing number of metastatic lymph nodes and a preablative stimulated thyroglobulin ?10 ng/ml were independent predictors of not achieving an excellent response after initial therapy.


    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133.
    2. Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. A 2010 Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20:1341–1349.
    3. Momesso DP, Vaisman F, Yang SP, Bulzico DA, Corbo R, Vaisman M, et al. Dynamic Risk Stratification in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine. J Clin Endocrinol Metab. 2016 Jul;101(7):2692-700.
    4. Tuttle RM. Outcomes of patients with differentiated thyroid cancer risk-stratified according to the American Thyroid Association and Latin American Thyroid Society risk of recurrence classification systems. Thyroid. 2013 Nov; 23(11): 1401-7.
    5. Shen FC, Hsieh CJ, Huang IC, Chang YH, Wang PW. Dynamic Risk Estimates of Outcome in Chinese Patients with Well-Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation. Thyroid. 2017 Apr;27(4):531-536.


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