A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up.
BACKGROUND
Although recurrence and death can occur in patients with papillary thyroid cancer (PTC) several years after being diagnosed, the necessary duration of follow-up for these patients remains unclear.


METHODS
This was a single-institution, retrospective review of 269 patients with PTC. Cox proportional hazards model and Kaplan-Meier curves were used to identify risk factors for recurrence and death. Risk predictors included age, sex, radiation exposure history, extent of operation, radioactive iodine treatment, follicular variant of PTC (FVPTC), extrathyroidal invasion, multifocality, TNM status, and stage.


RESULTS
Median follow-up was 27 years. Of 269 patients, 180 (66%) were female, and 196 (73%) were ≤45 years of age. Recurrence and cancer-specific death rates were 28% and 9%, respectively. Time to recurrence (±SD) was 8.1 (± 8.3) years and to cancer-specific death was 9.0 (± 11.0) years; however, 11% of recurrences and 17% of deaths occurred after 20 years. Risk factors for recurrence were older age, FVPTC, T4 tumors, cervical lymph node involvement, metastases, and stage ≥ 4a. Predictors of death from PTC were older age, metastases, and stage ≥ 3.


CONCLUSIONS
Both recurrences and death from PTC can occur more than 30 years after being treated, thus lifelong follow-up of patients with PTC is necessary.
Department of Surgery, Endocrine Surgery Research Program, University of Chicago Pritzker School of Medicine, Chicago, IL. Electronic address: rgrogan@surgery.bsd.uchicago.edu.
Raymon H
RH
Grogan
Sharone P
SP
Kaplan
Hongyuan
H
Cao
Roy E
RE
Weiss
Leslie J
LJ
Degroot
Cassie A
CA
Simon
Omran M A
OM
Embia
Peter
P
Angelos
Edwin L
EL
Kaplan
Rebecca B
RB
Schechter
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D013997:Time Factors