title: The impact of locoregional recurrences and distant metastases on the survival of patients with papillary thyroid carcinoma.
abstract: OBJECTIVE
  Some patients with papillary thyroid carcinoma (PTC) would suffer from locoregional recurrences or distant metastases. This study was aimed to elucidate the impacts of locoregional recurrences and distant metastases on these patients' survival.
  
  
  METHODS
  Retrospective hospital-based cohort study.
  
  
  METHODS
  Data were collected from 1636 subjects with PTC at National Taiwan University Hospital between 1985 and 2007.
  
  
  METHODS
  Overall and disease-specific survival curves were estimated by the Kaplan-Meier method. Time-independent and time-dependent prognostic factors were included simultaneously in multivariate analyses using Cox models.
  
  
  RESULTS
  Overall survival (OS) rates at 10- and 20-years were 90% and 76%, respectively. The 10- and 20-year disease-specific survival (DSS) rates were 95% and 90%, respectively. Our multivariate analyses identified that older age, distant metastases (hazard ratio, HR: 6·69, 95% CI: 4·40-10·18), locoregional recurrences (HR: 1·88, 95% CI: 1·22-2·89), lymph node metastases, massive extrathyroid extension, male gender and larger tumour size (>4 cm) were significantly associated with poorer OS. Older age, distant metastases (HR: 15·03, 95% CI: 8·31-27·21), locoregional recurrences (HR: 3·63, 95% CI: 2·03-6·51), massive extrathyroid extension, male gender and larger tumour size (>4 cm) were independently related to worse DSS. The performance of high-dose (131) I ablation had a protective effect on OS and DSS.
  
  
  CONCLUSIONS
  The locoregional recurrences had a moderately harmful impact on OS and DSS, but age and distant metastases were the major decisive factors for OS and DSS. High-dose (131) I ablation had a protective role. However, lymph node dissection did not alter the prognosis whenever lymph node metastases only influenced OS.
authors.affiliation: Department of Internal Medicine, Far-Eastern Polyclinic, Taipei, Taiwan; Division of Biostatistics, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Deng-Huang
authors.initials: DH
authors.lastname: Su
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Chang
authors.forename: Tien-Chun
authors.initials: TC
authors.lastname: Chang
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy; D013965:Thyroidectomy / Q000706:statistics & numerical data
chemical_list: D007457:Iodine Radioisotopes