Abstract
Background: For recurrent or metastatic radioactive iodine-refractory (RAI-R) papillary thyroid carcinoma (PTC), repetitive surgery is one form of local therapy that is evolving but hampered by technical challenges and complications. The goals of this study were to evaluate the efficacy of reoperations for local relapses of RAI-R PTC and to determine the effect of surgical treatment on disease progression.
Methods: We retrospectively reviewed data from patients with recurrent/metastatic RAI-R PTC who underwent revision operations at Hospital 108 between December 2018 and March 2021. We analyzed clinicopathological factors, perioperative features, biochemical and structural outcomes, disease progression, and related risk factors.
Results: Of the 71 patients with PTC (64 female, 7 male) enrolled in this study, 91.5% were in initial stages I and II, according to the American Joint Committee on Cancer Classification. All patients had undergone total thyroidectomy, and 61 (85.9%) had also undergone lymph node dissection (LND). The median radioactive iodine course and cumulative radioactive iodine dose were 2 times and 300 mCi, respectively. Surgery was performed in 9 (12.7%) patients for thyroid bed recurrence, 38 (53.5%) for central lymph node recurrence, and 53 (74.6%) for lateral lymph node recurrence. Major complications occurred in 9 (12.7%) patients. 15 (21.1%) patients had excellent responses, 16 (22.5%) had indeterminate responses, 33 (46.5%) had biochemically incomplete responses, and 7 (9.9%) had structurally incomplete responses. During follow-up (median time, 25 months), 21 (29.6%) patients suffered clinical and biochemical progression of disease. The median length of progression-free survival (PFS) was 27 months. Cox multifactor regression analyses revealed that the lymph node ratio and the incomplete (biochemical and structural) response were independent unfavorable prognostic factors for PFS.
Conclusions: Repetitive surgery is effective for locoregional RAI-R PTC recurrences/metastases and helps mitigate disease progression.
