Long term outcomes of simple clinical risk stratification in management of differentiated thyroid cancer

W L Craig, L Smart, S Fielding, C Ramsay, Z H Krukowski (Corresponding Author)

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Abstract

Objective: To establish the long term outcomes of risk stratified management of differentiated thyroid cancer (DTC).
Background: Guidelines for management of DTC lack a strong evidence base and expose patients to overtreatment. This prospective study of patients diagnosed with DTC between 1977-2012 describes the long term outcomes of a conservative risk stratified (AMES) management policy .
Methods: Outcomes were analysed around patient and tumour characteristics, primary intervention (surgery +/- radioiodine (RAI)), in terms of mortality, recurrence and reintervention.
Results: Median follow-up in 348 patients was 14 years: mean age 48 (range 10-

91) years, 257 (73.9%) female, 222 (68.3%) papillary cancer, tumour size 3.4 + 2.0 cm (mean + SD). 89 (25.6%) AMES high risk, 116 (33.3%) TNM stage III/IV and 16 (4.6%) had distant metastases. Primary surgery comprised lobectomy in 189 (54.3%): 11 (5.8%) patients had subsequent completion total thyroidectomy with cancer present in five. Primary nodal surgery was performed in 142 (40.8%) patients. 35 (13.5%) low and 43 (48.3%) high risk patients received RAI following initial surgery. Overall disease specific survival (DSS) was 92.1% at 10 years and 90.7% at 20 years. DSS at 20 years was 99.2% in low risk cases. AMES risk scoring predicted both survival and recurrence. Patients receiving RAI and AMES high risk were significantly associated with increased risk of death and recurrence.
Conclusions: Routine total thyroidectomy and RAI are not justifiable for low risk DTC. Treatment should be tailored to risk and AMES risk stratification remains a simple reliable clinical tool.
Original languageEnglish
Pages (from-to)283-291
Number of pages9
JournalThe Surgeon
Volume16
Issue number5
Early online date9 Mar 2018
DOIs
Publication statusPublished - Oct 2018

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Keywords

  • thyroid cancer
  • surgery
  • risk management
  • conservative therapy

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