Therapeutic outcomes of papillary thyroid carcinomas with tumors more advanced than T1N0M0

Purpose: This retrospective study analyzed the role of total or near-total thyroidectomy and adjuvant radioactive iodide (¹³¹I) therapy in papillary thyroid carcinoma patients with disease more advanced than T1N0M0. Methods: The study analyzed 1055 consecutive papillary thyroid cancer patients, 825 women and 230 men, who underwent near-total or total thyroidectomy, thyroid remnant ablation with ¹³¹I, and follow-up at Chang Gung Medical Center in Linkou, Taiwan. Patients with T1N0M0 stage tumors were excluded. Patients were categorized into four groups according to treatment outcome. Group A was disease-free patients with negative results of ¹³¹I whole body scan, undetected serum thyroglobulin (Tg) and Tg antibody, and no recurrence. Group B patients had no clinical evidence of persistent or recurrent thyroid cancer but were not in disease-free status. Group C were patients with cancer tissue persisting after surgery. Group D were patients suffering cancer recurrence after surgery and ¹³¹I ablation. Results: After a mean follow-up period of 10.1 ± 5.4 years (median: 9.5 years), 46 (4.36%) patients died of thyroid cancer. Nine Group A cases with persistent or recurrent cancer were treated until achieving disease-free status. Group C patients received the highest ¹³¹I dose but had a 25.7% mortality rate. In Group D, the mean duration from first thyroidectomy to recurrence was 5.1 ± 0.4 years and ranged from 0.8 to 18.7 years. Four of 56 (7.1%) patients with recurrent local neck cancer died of thyroid cancer and 12 (21.4%) died of thyroid cancer with distant metastases. Conclusions: Radioactive iodide therapy effectively controlled papillary thyroid carcinoma after neck surgery in 23.9% of patients. After surgery and ¹³¹I treatments, most patients with persistent or recurrent local-regional neck cancer were free of relapse; the cancer mortality rate was 19.0%.