title: Papillary thyroid cancer: time course of recurrences during postsurgery surveillance.
abstract: BACKGROUND
  The current use of life-long follow-up in patients with papillary thyroid cancer (PTC) is based largely on the study of individuals diagnosed and treated in the latter half of the 20th century when recurrence rates were approximately 20% and relapses detected up to 20-30 years after surgery. Since then, however, diagnosis, treatment, and postoperative monitoring of PTC patients have evolved significantly.
  
  
  OBJECTIVE
  The objective of the study was to identify times to PTC recurrence and rates by which these relapses occurred in a more recent patient cohort.
  
  
  METHODS
  We retrospectively analyzed follow-up data for 1020 PTC patients consecutively diagnosed in 1990-2008 in 8 Italian hospital centers for thyroid disease. Patients underwent thyroidectomy, with or without radioiodine ablation of residual thyroid tissue and were followed up with periodic serum thyroglobulin assays and neck sonography.
  
  
  RESULTS
  At the initial posttreatment (≤ 12 months) examination, 948 patients had no structural/functional evidence of disease. During follow-up (5.1-20.4 years; median 10.4 years), recurrence (cervical lymph nodes, thyroid bed) was diagnosed in 13 (1.4%) of these patients. All relapses occurred 8 or fewer years after treatment (10 within the first 5 years, 6 within the first 3 years). Recurrence was unrelated to the use/omission of postoperative radioiodine ablation.
  
  
  CONCLUSIONS
  In PTC patients whose initial treatment produces disease remission (no structural evidence of disease), recurrent disease is rare, and it usually occurs during the early postoperative period. The picture of recurrence timing during the follow-up provides a foundation for the design of more cost-effective surveillance protocols for PTC patients.
authors.affiliation: Dipartimento di Medicina Interna e Specialità Medica, Università di Roma Sapienza, V.le del Policlinico, 155, 00161 Rome, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Durante
authors.forename: Teresa
authors.initials: T
authors.lastname: Montesano
authors.forename: Massimo
authors.initials: M
authors.lastname: Torlontano
authors.forename: Marco
authors.initials: M
authors.lastname: Attard
authors.forename: Fabio
authors.initials: F
authors.lastname: Monzani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tumino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costante
authors.forename: Domenico
authors.initials: D
authors.lastname: Meringolo
authors.forename: Rocco
authors.initials: R
authors.lastname: Bruno
authors.forename: Fabiana
authors.initials: F
authors.lastname: Trulli
authors.forename: Michela
authors.initials: M
authors.lastname: Massa
authors.forename: Adele
authors.initials: A
authors.lastname: Maniglia
authors.forename: Rosaria
authors.initials: R
authors.lastname: D'Apollo
authors.forename: Laura
authors.initials: L
authors.lastname: Giacomelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronga
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Filetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy; D013997:Time Factors; D016896:Treatment Outcome