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.


    References:

    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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    Rocco Bellatone, Co-Chair
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    Jeremy Freeman, MD
    Ian J. Witterick, MD
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