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Incomplete response to therapy in intermediate- and high-risk thyroid cancer

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Abstract

Context

The American Thyroid Association (ATA) risk stratification system predicts risk of recurrence of differentiated thyroid cancer (DTC). Although the majority of patients achieve an excellent response, patients with intermediate- or high-risk DTC are at a significant risk of developing incomplete responses. We undertook this work to understand the factors associated with development of biochemically or structurally incomplete response in these two risk subgroups of DTC.

Patients and methods

We retrospectively reviewed 287 consecutive patients with intermediate- (213 patients) or high-risk (74 patients) DTC. All patients underwent total thyroidectomy with (223 patients) or without (64 patients) lymph node dissection and 94% of them received at least one dose of I-131ablation/therapy. Univariate and multivariate analysis and Kaplan Meier analysis were used to compare patients who achieved an excellent response with those who continued to have biochemically or structurally incomplete responses.

Results

In univariate and multivariate analyses, age (P 0.002, Odds ratio 4.8, 95% CI: 1.8–12.9), tumor size (P 0.027, Odds ratio 1.30, 95% CI: 1.03–1.64) and distant metastases (P < 0.0001, Odds ratio 44.6, 95% CI: 10.7–184.5) were significantly associated with the risk of developing biochemically or structurally incomplete statuses. Patients ≥ 55 years, tumors > 2.5 cm and presence of distant metastasis were associated with higher risk of incomplete response and death from DTC. However, when this analysis was performed on intermediate and high-risk groups separately, only age was consistently associated with risk of biochemically or structurally incomplete response in either and both groups.

Conclusion

Age is a strong predictor of biochemically and structurally incomplete responses in patients with intermediate and high-risk DTC.

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Acknowledgements

We would like to thank the patients and their families and our colleagues in the Section of Endocrinology, Department of Medicine, KFSHRC for their support.

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Authors and Affiliations

  1. Department of Medicine and Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Ali S. Alzahrani & Noha Mukhtar

  2. Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia

    Noha Mukhtar

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A.A.: Idea inception, designed the research, collected data, analysed the data and wrote the manuscript. N.M.: Collected and tabulated data, contributed in the analysis of the data, reviewed and edited the manuscript.

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Correspondence to Ali S. Alzahrani.

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Alzahrani, A.S., Mukhtar, N. Incomplete response to therapy in intermediate- and high-risk thyroid cancer. Endocrine 78, 531–542 (2022). https://doi.org/10.1007/s12020-022-03187-5

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