Related Experiment Video
Updated: Dec 3, 2025
Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
Published on: June 9, 2023
Evaluating the risk of re-recurrence in patients with persistent/recurrent thyroid carcinoma after initial
Siyuan Xu1, Qingfeng Li2, Zhiqi Wang3
1Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
Background:
Although the 2015 American Thyroid Association guidelines proposed initial and response-to-therapy risk stratifications were adequately validated in untreated papillary thyroid cancer patients, it is still unknown how they work in persistent/recurrent papillary thyroid cancer patients. This study aimed to evaluate and revise the stratifications in these patients.
Methods:
This retrospective study included patients who received the first reoperation with complete thyroid resection but without radioactive iodine ablation. Stratifications were performed considering the persistent/recurrent tumor characteristics and thyroglobulin levels 1 to 6 months after reoperation and then revised with new prognostic factors and adjusted thyroglobulin cutoff values, respectively. Prognostic performance was evaluated with Kaplan-Meier curves, proportion of variation explained, and Harrell's concordance index.
Results:
Among a total of 232 patients, 5-year re-recurrence free survival rates were 92.4%, 86.2%, and 74.5% in low-, intermediate-, and high-risk patients, respectively (all P > .05) and 97.0%, 96.3%, and 81.6% in excellent response, intermediate response, and biochemical incomplete response groups, respectively (excellent response versus intermediate response, P > .05; intermediate response versus biochemical incomplete response, P < .05). After incorporating age at reoperation, recurrent primary size, and recurrent lymph node number, the high-risk group had significantly compromised re-recurrence free survival versus the intermediate-risk group (76.2% vs 91.6%). After adjusting thyroglobulin values, 5-year re-recurrence free survival rates were 96.4%, 85.9%, and 75.8% in excellent response (<1 ng/mL), intermediate response (1-10 ng/mL), and biochemical incomplete response (≥10 ng/mL) groups, respectively (all P < .05), with a higher proportion of variation explained (12.8% vs 10.1%) and concordance index (0.669 vs 0.615) compared with the American Thyroid Association version.
Conclusion:
The revised American Thyroid Association initial and response-to-therapy risk stratifications have acceptable predictive value for persistent/recurrent papillary thyroid cancer patients.
