Postablation Stimulated Thyroglobulin Level is an Important Predictor of Biochemical Complete Remission after Reoperative Cervical Neck Dissection in Persistent/Recurrent Papillary Thyroid Carcinoma
The efficacy of reoperative cervical neck dissection (RND) in achieving biochemical complete remission (BCR) (or postreoperation stimulated thyroglobulin [sTg] of <0.5 ng/mL) remains unclear in persistent/recurrent papillary thyroid carcinoma (PTC). We hypothesized that lower postablation sTg levels would indicate a higher rate of BCR after RND. Our study examined the association between postablation sTg and BCR after one or more RNDs.
Of 199 patients who underwent RND, 81 patients were eligible. The postablation sTg levels (≤2 and >2 ng/mL) were correlated with the postreoperation sTg levels after RNDs. Patients’ clinicopathological characteristics, operative findings, and subsequent RNDs were compared between those with BCR after RNDs and those without.
Those with postablation sTg levels of ≤2 ng/mL had significantly higher BCR rate after the first RND (77.8 vs. 5.6 %, p < 0.001), overall BCR after one or more RNDs (77.8 vs. 9.3 %, p < 0.001), and better 5-year recurrence-free survival after the first RND (80.0 vs. 60.1 %, p = 0.049) than those with postablation sTg levels of >2 ng/mL. Overall BCR gradually decreased after each subsequent RND. Postablation sTg significantly correlated with postreoperation sTg (ρ = 0.509, p < 0.001). After adjusting for the number of metastatic lymph nodes excised at first RND and presence of extranodal extension, postablation sTg of ≤ 0.2 ng/mL was the only independent factor for BCR after one or more RNDs (odds ratio 37.0, 95 % confidence interval 5.68–250.0, p = 0.001).
Only a third of patients who underwent one or more RNDs for persistent/recurrent PTC had BCR afterward. Postablation sTg level was an independent factor for BCR. Completeness of the initial operation is important for the subsequent success of RND.
- Cancer incidence and mortality in Hong Kong. Hong Kong Cancer Registry, Hong Kong. 1983–2006. http://www3.ha.org.hk/cancereg/e_stat.asp. Accessed 15 Dec 2011.
- Lang, BH, Lo, CY, Chan, WF, Lam, KY, Wan, KY (2007) Prognostic factors in papillary and follicular thyroid carcinoma: implications for cancer staging. Ann Surg Oncol. 14: pp. 730-738 CrossRef
- Cooper, DS, Doherty, GM, Hauger, BR (2009) Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19: pp. 1167-1214 CrossRef
- Wong H, Wong KP, Yau T, et al. Is there a role for unstimulated thyroglobulin velocity in predicting recurrence in papillary thyroid carcinoma patients with detectable thyroglobulin after radioiodine ablation? Ann Surg Oncol. 2012. doi:10.1245/s10434-012-2391-6.
- Miyauchi, A, Kudo, T, Miya, A (2011) Prognostic impact of serum thyroglobulin doubling-time under thyrotropin suppression in patients with papillary thyroid carcinoma who underwent total thyroidectomy. Thyroid. 21: pp. 707-716 CrossRef
- Kloos, RT, Mazzaferri, EL (2005) A single recombinant human thyrotrophin–stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab. 90: pp. 5047-5057 CrossRef
- Malandrino, P, Latina, A, Marescalco, S (2011) Risk-adapted management of differentiated thyroid cancer assessed by a sensitive measurement of basal serum thyroglobulin. J Clin Endocrinol Metab. 96: pp. 1703-1709 CrossRef
- Hughes DT, Laird AM, Miller BS, Gauger PG, Doherty GM. Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. Ann Surg Oncol. 2012. doi:10.1245/s10434-012-2380-9.
- Yim, JH, Kim, WB, Kim, EY (2011) The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J Clin Endocrinol Metab. 96: pp. 2049-2056 CrossRef
- Schuff, KG, Weber, SM, Givi, B, Samuels, MH, Andersen, PE, Cohen, JI (2008) Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope. 118: pp. 768-775 CrossRef
- Al-Saif, O, Farrar, WB, Bloomston, M, Porter, K, Ringel, MD, Kloos, RT (2010) Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab. 95: pp. 2187-2194 CrossRef
- Lang, BH, Wong, KP, Wan, KY, Lo, CY (2012) Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol. 19: pp. 60-67 CrossRef
- Lang, BH, Lo, CY, Chan, WF, Lam, KY, Wan, KY (2007) Staging systems for papillary thyroid carcinoma: a review and comparison. Ann Surg. 245: pp. 366-378 CrossRef
- Sohn, YM, Kwak, JY, Kim, EK, Moon, HJ, Kim, SJ, Kim, MJ (2010) Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 194: pp. 38-43 CrossRef
- Farrag, TY, Agrawal, N, Sheth, S (2007) Algorithm for safe and effective reoperative thyroid bed surgery for recurrent/persistent papillary thyroid carcinoma. Head Neck. 29: pp. 1069-1074 CrossRef
- Kouvaraki, MA, Lee, JE, Shapiro, SE, Sherman, SI, Evans, DB (2004) Preventable reoperations for persistent and recurrent papillary thyroid carcinoma. Surgery. 136: pp. 1183-1191 CrossRef
- Wong, KP, Lang, BH (2011) The role of prophylactic central neck dissection in differentiated thyroid carcinoma: issues and controversies. J Oncol. 2011: pp. 127929 CrossRef
- Postablation Stimulated Thyroglobulin Level is an Important Predictor of Biochemical Complete Remission after Reoperative Cervical Neck Dissection in Persistent/Recurrent Papillary Thyroid Carcinoma
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Annals of Surgical Oncology
Volume 20, Issue 2 , pp 653-659
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