title: Factors determining the persistence or recurrence of well-differentiated thyroid cancer treated by thyroidectomy and/or radioiodine in the Boston, Massachusetts area: A retrospective chart review.
abstract: OBJECTIVE
  To assess predictors of well-differentiated thyroid cancer (WDTC) persistence/recurrence.
  
  
  METHODS
  This was a retrospective chart review of thyroid carcinoma patients seen 1979-2007 in a Boston, Massachusetts-area multispecialty group. Of 1,025 patients, 431 met eligibility criteria. Cox proportional hazards models were used to assess predictors (gender, age, ethnicity, tumor size, surgical histology) of WDTC persistence/recurrence (elevated thyroglobulin levels with negative thyroglobulin-antibodies; or positive imaging). Local extension of disease and lymph node involvement could not be assessed.
  
  
  RESULTS
  Mean age at initial surgery (n = 431, 74% women, 79% Caucasian) was 45.8 ± 13.5(SD) years. Mean tumor (papillary, 91%; follicular, 5%; Hurthle cell, 2%; ≥1 type, 2%) size was 2.5 ± 1.6(SD) cm. Most tumors were unifocal (57%) and ≥1 cm (89%). Over 2,600 person-years of follow-up, persistence/recurrence occurred in 52 patients (12%) 4.3 years (median; range 0.2-23.2 years) after surgery. Gender, ethnicity, tumor size, multifocality, and histology were not predictive of persistence/recurrence, while older age was predictive in some models.
  
  
  CONCLUSIONS
  In WDTC patients treated by total and near total thyroidectomy and radioiodine and analyzed without consideration of local, locoregional, and distant extent of disease, neither size of tumor nor male gender contribute to disease persistence/recurrence. Age at diagnosis seems to have some positive prognostic value even if only patients older than 21 years at diagnosis are considered. Due to the rare occurrence of follicular (also oxyphilic) histotype, this conclusion refers mainly to patients with papillary thyroid cancer.
authors.affiliation: Section of Endocrinology, Diabetes, and Nutrition; Boston University School of Medicine; Boston, MA; USA. angela.leung@bmc.org.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Leung
authors.forename: Shalini
authors.initials: S
authors.lastname: Dave
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Lee
authors.forename: Francis X
authors.initials: FX
authors.lastname: Campion
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Garber
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Pearce