title: Clinical outcomes of patients with papillary thyroid carcinoma after the detection of distant recurrence.
abstract: OBJECTIVE
  Papillary thyroid carcinoma generally has an excellent prognosis but can have recurrence to the distant organs that is often life-threatening. To date, prognosis and prognostic factors of papillary carcinoma have been intensively investigated, but our knowledge regarding prognosis after the detection of distant recurrence remains inadequate.
  
  
  METHODS
  We investigated the prognosis and prognostic factors of papillary carcinoma after distant recurrence was detected during follow-up in a series of 105 patients who underwent locally curative surgery between 1987 and 2004.
  
  
  RESULTS
  To date, 30 patients (29%) have died of carcinoma, and the 5-year and 10-year cause-specific survival (CSS) rates after the detection of distant recurrence were 71 and 50%, respectively. Patients aged 55 years or older at recurrence or with massive extrathyroid extension of primary lesions demonstrated a significantly worse CSS. On multivariate analysis, these two parameters were recognized as independent prognostic factors. Gender, tumor size, and lymph node metastasis did not affect patient prognosis. Uptake of radioactive iodine (RAI) to distant metastasis was not significantly linked to CSS, but none of the patients younger than aged 55 years showing RAI uptake died of carcinoma. Appearance of distant recurrence to organs other than lung also predicted a dire prognosis.
  
  
  CONCLUSIONS
  Age at recurrence and extrathyroid extension of primary lesions were significantly related to patient prognosis after the detection of distant recurrence. RAI therapy is effective, especially for younger patients, if metastatic lesions show RAI uptake.
authors.affiliation: Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe City, 650-0011, Japan. ito01@kuma-h.or.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Takuya
authors.initials: T
authors.lastname: Higashiyama
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Takamura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miya
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000556:secondary* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult