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%.