Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome
Abstract Background In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on r...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-020-07269-3 |
| _version_ | 1818109492933427200 |
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| author | Renaud Ciappuccini Natacha Heutte Audrey Lasne-Cardon Virginie Saguet-Rysanek Camille Leroy Véronique Le Hénaff Dominique Vaur Emmanuel Babin Stéphane Bardet |
| author_facet | Renaud Ciappuccini Natacha Heutte Audrey Lasne-Cardon Virginie Saguet-Rysanek Camille Leroy Véronique Le Hénaff Dominique Vaur Emmanuel Babin Stéphane Bardet |
| author_sort | Renaud Ciappuccini |
| collection | DOAJ |
| description | Abstract Background In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome. Methods This retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or 18FDG PET/CT without identifiable lesions on anatomic imaging. Small- and large-volume PD were defined by lesions with a largest size < 10 or ≥ 10 mm respectively. Results PD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively, p < 0.0001). There was a significant trend for a decrease in excellent response rate from the very small-, small- to large-volume PD groups at 9–12 months after initial therapy (71, 20 and 7%, respectively; p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively; p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and 18FDG-positive PD were independent risk factors for indeterminate or incomplete response at last follow-up visit. Conclusions The tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment. |
| first_indexed | 2024-12-11T02:32:07Z |
| format | Article |
| id | doaj.art-5d3fba551a814e28ba927468a304e632 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-11T02:32:07Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-5d3fba551a814e28ba927468a304e6322022-12-22T01:23:49ZengBMCBMC Cancer1471-24072020-08-0120111210.1186/s12885-020-07269-3Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcomeRenaud Ciappuccini0Natacha Heutte1Audrey Lasne-Cardon2Virginie Saguet-Rysanek3Camille Leroy4Véronique Le Hénaff5Dominique Vaur6Emmanuel Babin7Stéphane Bardet8Department of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer CentreCETAPS EA 3832, Rouen UniversityDepartment of Head and Neck Surgery, François Baclesse Cancer CentreDepartment of Pathology, François Baclesse Cancer CentreDepartment of Oncology, François Baclesse Cancer CentreDepartment of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer CentreDepartment of Cancer Biology and Genetics, François Baclesse Cancer CentreINSERM 1086 ANTICIPE, Caen UniversityDepartment of Nuclear Medicine and Thyroid Unit, François Baclesse Cancer CentreAbstract Background In patients with differentiated thyroid cancer (DTC), tumor burden of persistent disease (PD) is a variable that could affect therapy efficiency. Our aim was to assess its correlation with the 2015 American Thyroid Association (ATA) risk-stratification system, and its impact on response to initial therapy and outcome. Methods This retrospective cohort study included 618 consecutive DTC patients referred for postoperative radioiodine (RAI) treatment. Patients were risk-stratified using the 2015 ATA guidelines according to postoperative data, before RAI treatment. Tumor burden of PD was classified into three categories, i.e. very small-, small- and large-volume PD. Very small-volume PD was defined by the presence of abnormal foci on post-RAI scintigraphy with SPECT/CT or 18FDG PET/CT without identifiable lesions on anatomic imaging. Small- and large-volume PD were defined by lesions with a largest size < 10 or ≥ 10 mm respectively. Results PD was evidenced in 107 patients (17%). Mean follow-up for patients with PD was 7 ± 3 years. The percentage of large-volume PD increased with the ATA risk (18, 56 and 89% in low-, intermediate- and high-risk patients, respectively, p < 0.0001). There was a significant trend for a decrease in excellent response rate from the very small-, small- to large-volume PD groups at 9–12 months after initial therapy (71, 20 and 7%, respectively; p = 0.01) and at last follow-up visit (75, 28 and 16%, respectively; p = 0.04). On multivariate analysis, age ≥ 45 years, distant and/or thyroid bed disease, small-volume or large-volume tumor burden and 18FDG-positive PD were independent risk factors for indeterminate or incomplete response at last follow-up visit. Conclusions The tumor burden of PD correlates with the ATA risk-stratification, affects the response to initial therapy and is an independent predictor of residual disease after a mean 7-yr follow-up. This variable might be taken into account in addition to the postoperative ATA risk-stratification to refine outcome prognostication after initial treatment.http://link.springer.com/article/10.1186/s12885-020-07269-3Differentiated thyroid cancerTumor burdenRisk-stratificationRadioiodine18FDG PET/CT |
| spellingShingle | Renaud Ciappuccini Natacha Heutte Audrey Lasne-Cardon Virginie Saguet-Rysanek Camille Leroy Véronique Le Hénaff Dominique Vaur Emmanuel Babin Stéphane Bardet Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome BMC Cancer Differentiated thyroid cancer Tumor burden Risk-stratification Radioiodine 18FDG PET/CT |
| title | Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome |
| title_full | Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome |
| title_fullStr | Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome |
| title_full_unstemmed | Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome |
| title_short | Tumor burden of persistent disease in patients with differentiated thyroid cancer: correlation with postoperative risk-stratification and impact on outcome |
| title_sort | tumor burden of persistent disease in patients with differentiated thyroid cancer correlation with postoperative risk stratification and impact on outcome |
| topic | Differentiated thyroid cancer Tumor burden Risk-stratification Radioiodine 18FDG PET/CT |
| url | http://link.springer.com/article/10.1186/s12885-020-07269-3 |
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