title: Predictors for papillary thyroid cancer persistence and recurrence: a retrospective analysis with a 10-year follow-up cohort study.
abstract: We aimed to determine outcome predictors of papillary thyroid cancer (PTC) persistence and recurrence, separately.
  
  
  
  The factors contributing to either persistence or recurrence of PTC are poorly defined, as both outcomes are usually evaluated together.
  
  
  
  In this 10-year follow-up cohort study, 190 PTC patients were evaluated (18-85 years old; registered from 1 January 1990 to31 December 1999 at a Brazilian Cancer Care referral Hospital). After initial surgery, we examined persistence (disease detected up to 1 year), recurrence (disease detected after 1 year) and PTC-free status (disease absence during follow-up).
  
  
  
  Outcome predictors were modelled using multinomial logit regression analysis.
  
  
  
  The univariate analysis showed that persistence and recurrence were significantly associated with lymph node metastasis (OR = 12·33; OR = 2·84, respectively), local aggressiveness (OR = 5·22; OR = 3·35) and extrathyroidal extension (OR = 5·07; OR = 7·11). Persistence was associated with male sex (OR = 3·49), age above 45 years old at diagnosis (OR = 1·03), macroscopic lymph node metastasis (OR = 5·85), local aggressiveness (OR = 5·22), each 1-cm tumour size increase (OR = 1·34), a cancer care referral hospital as the place of initial surgery (OR = 2·3), thyroidectomy or near total thyroidectomy(OR = 3·03) and neck dissection (OR = 3·19). Recurrence was associated with the time of radioactive iodine ((131) I) therapy (OR = 3·71). After data modelling, persistence was associated with macroscopic lymph node metastasis (OR = 6·17), 1-cm increases in tumour size (OR = 1·30) and thyroidectomy or near total thyroidectomy (OR = 3·82), while recurrence was associated with surgery at referral hospital (OR = 3·79).
  
  
  
  The best predictors of persistence were tumour size and macroscopic lymph node metastasis; when the initial surgery is of quality, the recurrence depends more on tumour's biology aspects.
authors.affiliation: Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.|Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil.
authors.forename: Taciana Padilha
authors.initials: TP
authors.lastname: de Castro
authors.affiliation: Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil.
authors.forename: William
authors.initials: W
authors.lastname: Waissmann
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health - DEMQS-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil.
authors.forename: Taynãna César
authors.initials: TC
authors.lastname: Simões
authors.affiliation: Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.|Cancer Hospital 1, National Institute of Cancer INCA, Rio de Janeiro, RJ, Brazil.
authors.forename: Rossana Corbo R
authors.initials: RC
authors.lastname: de Mello
authors.affiliation: Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.|Carlos Chagas Filho Institute of Biophysics - IBCCF/UFRJ, Rio de Janeiro, RJ, Brazil.
authors.forename: Denise P
authors.initials: DP
authors.lastname: Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes