Prognostic factors for incomplete response in thyroid microcarcinoma: an analysis of initial response to therapy in 517 patients
| Autor: | Rosalia P. Padovani, Fernanda Nascimento Faro, Adriano Namo Cury, Carolina Ferraz, Gustavo Piech Ricardo, Marília Martins Marone, Vivian Roberta Ferreira Simões, Nilza Maria Scalissi, Cristal Peters Cabral, Karina Braga Ribeiro |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Endocrinology Diabetes and Metabolism Perineural invasion Thyroid neoplasms 030209 endocrinology & metabolism Disease Gastroenterology Diseases of the endocrine glands. Clinical endocrinology Metastasis Iodine Radioisotopes 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Thyroid Neoplasms Retrospective Studies Receiver operating characteristic business.industry Thyroid active surveillance prognostic factors Retrospective cohort study multifocality Middle Aged medicine.disease RC648-665 Prognosis Lymphatic system medicine.anatomical_structure 030220 oncology & carcinogenesis Thyroidectomy Medicine thyroid microcarcinoma Female Lymph Neoplasm Recurrence Local business |
| Zdroj: | Archives of Endocrinology and Metabolism, Issue: ahead, Published: 29 MAR 2021 Archives of Endocrinology and Metabolism, Volume: 65, Issue: 5, Pages: 579-587, Published: 29 MAR 2021 Archives of Endocrinology and Metabolism v.65 n.5 2021 Arquivos de Endocrinologia e Metabolismo Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) instacron:SBEM Archives of Endocrinology and Metabolism, Vol 65, Iss 5, Pp 579-587 (2021) |
| ISSN: | 2359-4292 |
| Popis: | Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into “favorable” (excellent/indeterminate) or “unfavorable” (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups. |
| Databáze: | OpenAIRE |
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