Context: Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer.
Objective: The objective was to examine effects of initial therapies on outcomes.
Design/setting: This was a prospective multi-institutional registry.
Patients: A total of 4941 patients, median follow-up, 6 years, participated.
Intervention: Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST).
Main Outcome Measure: Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses.
Results: Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1-3.
Conclusions: We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393522 | PMC |
| http://dx.doi.org/10.1210/JC.2015-1346 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012.
J Clin Endocrinol Metab
September 2015
Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219.
Context: Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer.
Objective: The objective was to examine effects of initial therapies on outcomes.
Recombinant human thyroid-stimulating hormone (rhTSH): clinical development.
J Endocrinol Invest
April 2000
Medical, Clinical and Regulatory Affairs, Genzyme Europe, Naarden, The Netherlands.
Recombinant human thyroid-stimulating hormone (rhTSH) was developed to safely provide exogenous TSH stimulation in patients on thyroid hormone suppression therapy (THST), which is integral to long-term management of well-differentiated thyroid cancer. Such stimulation allows detection of thyroid remnant and neoplastic tissue by serum thyroglobulin (Tg) testing and/or diagnostic iodine-131 (I-131) imaging, sparing patients THST withdrawal and resultant metabolic impairment, discomfort and morbidity needed to obtain endogenous TSH stimulation. An extensive clinical development process including nearly a decade of multinational, multicentre study or other follow-up of over 500 patients has demonstrated that: 1) rhTSH is safe and well-tolerated, with the main side effects transient, mild to moderate nausea in approximately 11% or headache in approximately 7% of patients.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!