Disease Severity at Presentation in Patients with Disease-Related Mortality from Differentiated Thyroid Cancer: Implications for the 2015 ATA Guidelines.

Disease Severity at Presentation in Patients with Disease-Related Mortality from Differentiated Thyroid Cancer: Implications for the 2015 ATA Guidelines.

Thyroid. 2017 Aug 09;:

Authors: Robenshtok E, Nachalon Y, Benbassat C, Hirsch D, Shimon I, Grossman A, Diker-Cohen T, Akirov A, Popovtzer A

Abstract
BACKGROUND: The current trend of less aggressive treatment of low-risk differentiated thyroid cancer (DTC) patients was recently challenged by a study reporting >10% disease-related mortality (DRM) in low-risk patients ablated with radioiodine activity of <54mCi. However, this study and others were limited by incomplete data on disease severity at presentation. Whether patients presenting with low risk disease are at risk for disease-related mortality is crucial for planning current treatment strategies.
METHODS: Patients with documented DRM from DTC were included from the Rabin thyroid cancer registry and the Davidoff Head & Neck cancer clinic databases. Disease characteristics at presentation, treatments, disease course, and cause of death were analyzed.
RESULTS: Of 1,374 patients charts reviewed, 56 patients were confirmed to have died of DTC, and 53 had sufficient data for analysis. Median time from diagnosis to death was 9 years (range 1-36). Cause of death was related to distant metastases in 46 patients and aggressive neck disease in 7 patients. The median age at diagnosis was 62 years (range 22-83, 83% older than 45), and were initially categorized as ATA high risk in 89% of cases (in 4 cases due to high thyroglobulin levels), intermediate risk in 6% (three older patients with N1b disease), misclassification as benign in one case, and none was low risk. Most patients had upfront advanced disease stage (stage IV-88%, III-2%, II-2%, I-8%). All patients with stage I disease were <45 years, with aggressive features (1 poorly differentiated, 3 gross extra-thyroidal extension). One patient with stage II disease was <45 year with distant metastases. Detection of distant metastases was within the first year in 25 patients, and during follow-up in 25 patients. Overall, apart from one patient who was misdiagnosed as benign follicular adenoma at presentation, all patients had aggressive disease features at presentation.
CONCLUSION: None of the patients with DRM had low risk features at presentation, supporting the current paradigm of less aggressive approach in this group. Studies analyzing mortality from thyroid cancer should categorize patients as low risk based on full baseline data, including post-operative thyroglobulin levels.

PMID: 28791923 [PubMed - as supplied by publisher]

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