Low Long-Term Recurrence Rate for Thyroid Cancer

By Will Boggs, MD NEW YORK (Reuters Health) Mar 23 - Long-term recurrence rates are low for patients with papillary and follicular thyroid cancer, especially when their initial thyroglobulin levels are low, according to a report in the March 9th online issue of The Journal of Clinical Endocrinology & Metabolism. "In our study, the prognosis of our cohort of 715 differentiated thyroid cancer patients without evidence of residual disease after radioiodine ablation was very good," Dr. Maryse Brassard from Institut Gustave Roussy, Villejuif, France, told Reuters Health in an email. "The patients who have not recurred at 6.2 years of median follow-up can be followed with annual basal thyroglobulin only if they have no circulating anti-thyroglobulin antibodies." Dr. Brassard and colleagues evaluated the recurrence rate in 715 patients with differentiated thyroid cancer who had no evidence of persistent disease after total thyroidectomy followed by radioiodine ablation and assessed the predictive value of the initial thyroglobulin level for detecting recurrence. Thirty-two patients experienced recurrences, including 26 during the first 5 years, for a recurrence rate of 4.2% at 5 years. All 32 patients with recurrences had been treated with 100 mCi 131I. Recurrence rates were lowest in patients with pT1-T2 N0 disease (7/424, 1.7%) and highest in patients with pT3-T4 N1 disease (11/59, 18.6%), but overall recurrence rates didn't differ for papillary and follicular cancers (5% each). Initial thyroglobulin levels (3-4 months after radioiodine ablation) of 0.27 ng/mL provided 72% sensitivity, 86% specificity, 20% positive predictive value, and 99% negative predictive value for recurrence of thyroid cancer. Later thyroglobulin levels (9-12 months after radioiodine ablation) of 1.4 ng/mL stimulated by TSH provided similar sensitivity (78%), specificity (90%), positive predictive value (26%), and negative predictive value (99%). Only 6 of 572 patients with both thyroglobulin levels below the cutoff values experienced a recurrence, but there was no relationship between thyroglobulin levels at either time point with recurrence or time to recurrence in the 32 patients who experienced a recurrence. Median early and late thyroglobulin levels were lower in patients with neck recurrences than in those with recurrence at distant sites, the researchers note, suggesting that the burden of disease is smaller in those with neck recurrences.

"This indicates that even low serum thyroglobulin levels should be taken into consideration and that neck ultrasound should be performed in all patients, in accordance with guidelines," the investigators say. "This is further emphasized by the discovery of a neck recurrence in 3 patients whose serum thyroglobulin levels at baseline were undetectable and in whom serum thyroglobulin on levothyroxine was still undetectable at the time of recurrence." "There is no need to perform a stimulated thyroglobulin if the basal thyroglobulin at 3 months after ablation is less than 0.27 ng/mL in patients without evidence of extra-thyroidal captation on the whole body scan," Dr. Brassard said. "TSH stimulation improves the positive predictive value of serum thyroglobulin determination only in patients with a thyroglobulin level on levothyroxine greater than 0.27 ng/mL," the authors add. SOURCE: http://bit.ly/fk3kOT J Clin Endocrinol Metab 2011.