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Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment
BACKGROUND: Papillary thyroid cancer (PTC) has an excellent prognosis, and recurrence is rare in patients with no evidence of disease (NED) after initial treatment. Despite this, several guidelines recommend long and costly follow-up, with limited evidence of improved patient outcomes. This study ai...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8659350/ https://www.ncbi.nlm.nih.gov/pubmed/34882764 http://dx.doi.org/10.1093/bjsopen/zrab119 |
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author | Nordell, Fabian Hallal, Ghadir Asp, Pernilla Almquist, Martin |
author_facet | Nordell, Fabian Hallal, Ghadir Asp, Pernilla Almquist, Martin |
author_sort | Nordell, Fabian |
collection | PubMed |
description | BACKGROUND: Papillary thyroid cancer (PTC) has an excellent prognosis, and recurrence is rare in patients with no evidence of disease (NED) after initial treatment. Despite this, several guidelines recommend long and costly follow-up, with limited evidence of improved patient outcomes. This study aims to examine the value of follow-up in patients with NED after treatment for PTC, by determining the rate of recurrence, recurrence-associated morbidity, and death, and whether any recurrence was diagnosed through the follow-up programme. METHODS: Patients operated for PTC at Lund University Hospital between January 2004 and December 2016 were eligible. Patients with T1a N0/NX were excluded as well as patients with any other thyroid malignancy. Data were collected retrospectively by searching the patients’ medical records. NED was defined as thyroglobulin less than 1 ng/ml, thyroglobulin antibodies less than 20 kIU/l, and negative imaging. Biochemical recurrence was defined as thyroglobulin greater than 1 ng/ml, and/or thyroglobulin antibodies greater than 20 kIU/l. Structural recurrence was defined as a strong suspicion of recurrence on imaging and/or histological proof of recurrence. RESULTS: Out of a cohort of 187 patients, there were 90 patients with NED who were followed for a median of 6.3 years. Three patients had biochemical recurrence; none of them had symptoms, nor were they treated for their recurrence. Three had structural recurrence; all were above 75 years old and only one was diagnosed through the follow-up programme. No patient died of PTC; five patients died during the follow-up. CONCLUSION: Follow-up as it is designed today cannot identify recurrences accurately and seems to be of questionable benefit in younger patients with NED after treatment for PTC. |
format | Online Article Text |
id | pubmed-8659350 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-86593502021-12-10 Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment Nordell, Fabian Hallal, Ghadir Asp, Pernilla Almquist, Martin BJS Open Original Article BACKGROUND: Papillary thyroid cancer (PTC) has an excellent prognosis, and recurrence is rare in patients with no evidence of disease (NED) after initial treatment. Despite this, several guidelines recommend long and costly follow-up, with limited evidence of improved patient outcomes. This study aims to examine the value of follow-up in patients with NED after treatment for PTC, by determining the rate of recurrence, recurrence-associated morbidity, and death, and whether any recurrence was diagnosed through the follow-up programme. METHODS: Patients operated for PTC at Lund University Hospital between January 2004 and December 2016 were eligible. Patients with T1a N0/NX were excluded as well as patients with any other thyroid malignancy. Data were collected retrospectively by searching the patients’ medical records. NED was defined as thyroglobulin less than 1 ng/ml, thyroglobulin antibodies less than 20 kIU/l, and negative imaging. Biochemical recurrence was defined as thyroglobulin greater than 1 ng/ml, and/or thyroglobulin antibodies greater than 20 kIU/l. Structural recurrence was defined as a strong suspicion of recurrence on imaging and/or histological proof of recurrence. RESULTS: Out of a cohort of 187 patients, there were 90 patients with NED who were followed for a median of 6.3 years. Three patients had biochemical recurrence; none of them had symptoms, nor were they treated for their recurrence. Three had structural recurrence; all were above 75 years old and only one was diagnosed through the follow-up programme. No patient died of PTC; five patients died during the follow-up. CONCLUSION: Follow-up as it is designed today cannot identify recurrences accurately and seems to be of questionable benefit in younger patients with NED after treatment for PTC. Oxford University Press 2021-12-09 /pmc/articles/PMC8659350/ /pubmed/34882764 http://dx.doi.org/10.1093/bjsopen/zrab119 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Nordell, Fabian Hallal, Ghadir Asp, Pernilla Almquist, Martin Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title | Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title_full | Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title_fullStr | Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title_full_unstemmed | Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title_short | Optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
title_sort | optimization of follow-up in patients with papillary thyroid cancer who show no evidence of disease 9–12 months after treatment |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8659350/ https://www.ncbi.nlm.nih.gov/pubmed/34882764 http://dx.doi.org/10.1093/bjsopen/zrab119 |
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