Chung, Eun-Jae1; Jeong, Woo-Jin1; Jung, Young Ho1; Kwon, Seong Keun1; Kwon, Tack-Kyun1; Sung, Myung-Whun1; Ahn, Soon-Hyun1; Kim, Kwang-Hyun1; Lee, Kyu-Eun2; Kim, Su-jin2; Kim, Min-Joo3; Cho, Sun-Wook3; Park, Young-Joo3
1 Department of Otorhinolaryngology – Head and Neck Surgery, Seoul National University Hospital; Seoul National University College of Medicine, Seoul, Korea
2 Department of Internal Medicine, Seoul National University Hospital; Seoul National University College of Medicine, Seoul, Korea
3 Department of Surgery, Seoul National University Hospital; Seoul National University College of Medicine, Seoul, Korea
Purpose: The purpose of this study is to analyze the clinical feature and prognostic factor of the locoregionally recurrent/ persistent well differentiated thyroid ca(WDTC)
Methods: Among the cohort of 660 patients with recurrent/persistent WDTC, 145 consecutive patients were preliminarily reviewed. Patients with biochemical disease after 1st surgery (n=21), distant metastasis (n=21), and insufficient data (n=8) were excluded. Consequently, a total of 86 patients were analyzed in this study. Eighty-one patients (95.2%) had papillary thyroid carcinoma, 3 patients (3.2%) follicular thyroid carcinoma, 2 patient poorly differentiated carcinoma (1.6%)
Results: The median time to recurrence was 21 months (2-156mo). Local recurrence developed in 9 and regional recurrence in73 locoregional 5 patients. The mode of recurrence detection included ultrasound (n=59), 131I scan (n=8), PET-CT scan (n=12), CT scan (n=6), and patient’s symptom (n=1). The salvage treatment included surgery (n=49), surgery with 131I ablation (RAI; n=24), surgery with RAI and external radiation (n=3), 131I ablation (n=1), Radiofrequency ablation (n=4), and observation (n=5). The overall 10, 5, 2, 1-year recurrence-free survival rate was 66.1%, 79%, 80.6%, 87.1%, repectively. The final disease states with no evidence of disease in 55 (NED, 64%) patients, biochemical disease in 14 (16.2%) patients, and persistent disease in 17 (19.8%) patients. The final NED rate were 69.4%, 77.8%, 33.3%, 0%, 50%, 0% for each treatment modalities. The final NED state is significantly lower in old age patients, larger tumor (?4 cm), higher thyroglobulin level, ?5 metastatic lymph nodes, treatment modality with observation
Conclusion: Recurrent/ persistent WDTC can be treated effectively with reoperative surgical excision.