title: Recurrent differentiated thyroid carcinoma: biological implications of age, method of detection, and site and extent of recurrence.
abstract: BACKGROUND
  We identified factors predictive of outcome for recurrent differentiated thyroid carcinoma (DTC).
  
  
  METHODS
  Fifty-seven patients with local (LR), regional (RRec), and/or distant recurrence (DR) of 431 recurrent DTCs were studied. Disease-specific survival (DSS) rate was estimated with the Kaplan-Meier method. Univariate and multivariate comparisons were conducted by log-rank and Cox regression analysis.
  
  
  RESULTS
  The median follow-up was 13 years. Distribution of the first relapse was LR only (35%), LR and RRec (23%), LR and DR (30%), and LR, RRec, and DR (12%). Factors predictive of resectability were a long (>or=5-year) disease-free interval (DFI) and subclinical and thyroid remnant recurrence. Only 26% of symptomatic and 45% of thyroid bed LR, and 43% with DFI <5 years, could be resected completely. No isolated thyroid remnant and 75% of thyroid bed LR resulted in tumor-related mortality. Age <45 years, subclinical recurrence, isolated LR, and the ability to render the patient disease free independently predicted DSS. Fifteen-year DSS for LR only; LR and RRec; LR and DR; and LR, RRec, and DR were 49%, 28%, 15%, and 0%, respectively.
  
  
  CONCLUSIONS
  Isolated thyroid remnant recurrence defines a benign phenotype. Age, method of detection, site and extent of recurrence, and the ability to render the patient disease free predict outcome for recurrent DTC. Multimodality long-term follow-up is warranted to detect recurrence at a subclinical potentially curative stage.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York , USA. ta.stojadinovic@verizon.net
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Margo
authors.initials: M
authors.lastname: Shoup
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Ghossein
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery