title: Outcome after treatment of high-risk papillary and non-Hürthle-cell follicular thyroid carcinoma.
abstract: BACKGROUND
  Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial.
  
  
  OBJECTIVE
  To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high-risk papillary and non-Hürthle-cell follicular thyroid carcinoma.
  
  
  METHODS
  Analysis of data from a multicenter study.
  
  
  METHODS
  14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry.
  
  
  METHODS
  385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma).
  
  
  METHODS
  Death, disease progression, and disease-free survival.
  
  
  RESULTS
  Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine-131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease-free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival.
  
  
  CONCLUSIONS
  This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.
authors.affiliation: University of Cincinnati Medical Center, Ohio 45267, USA.
authors.forename: T
authors.initials: T
authors.lastname: Taylor
authors.forename: B
authors.initials: B
authors.lastname: Specker
authors.forename: J
authors.initials: J
authors.lastname: Robbins
authors.forename: M
authors.initials: M
authors.lastname: Sperling
authors.forename: M
authors.initials: M
authors.lastname: Ho
authors.forename: K
authors.initials: K
authors.lastname: Ain
authors.forename: S T
authors.initials: ST
authors.lastname: Bigos
authors.forename: J
authors.initials: J
authors.lastname: Brierley
authors.forename: D
authors.initials: D
authors.lastname: Cooper
authors.forename: B
authors.initials: B
authors.lastname: Haugen
authors.forename: I
authors.initials: I
authors.lastname: Hay
authors.forename: V
authors.initials: V
authors.lastname: Hertzberg
authors.forename: I
authors.initials: I
authors.lastname: Klein
authors.forename: H
authors.initials: H
authors.lastname: Klein
authors.forename: P
authors.initials: P
authors.lastname: Ladenson
authors.forename: R
authors.initials: R
authors.lastname: Nishiyama
authors.forename: D
authors.initials: D
authors.lastname: Ross
authors.forename: S
authors.initials: S
authors.lastname: Sherman
authors.forename: H R
authors.initials: HR
authors.lastname: Maxon
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000367:Age Factors; D002291:Carcinoma, Papillary / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes