Long-term clinical outcomes of papillary thyroid carcinoma patients with biochemical incomplete response
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The aim of this study was to evaluate the long-term clinical outcomes of papillary thyroid carcinoma (PTC) patients exhibiting biochemical incomplete response (BIR) to initial therapy.
We evaluated 102 patients with PTC showing a BIR during the first 12–24 months after total thyroidectomy and radioactive iodine therapy. Patients were divided into three groups according to changes in stimulated thyroglobulin (Tg) and anti-Tg antibody (TgAb) levels: the increasing TgAb group (n = 19, 18.6%), the decreasing Tg group (n = 58, 56.9%), and the increasing Tg group (n = 25, 24.5%).
With a median follow-up of 12 years, 43 (42%) patients had structural persistent disease as follows: 36 (84%) at regional sites and 7 (16%) at distant sites. The rate of structural persistent disease was significantly different between groups, with 21%, 41%, and 60% in the increasing TgAb, decreasing Tg, and increasing Tg groups, respectively (P = 0.012). Among patients without structural persistent disease, only 19 (18.6%) showed no evidence of disease and 40 (39.2%) were of a biochemical persistent status at the time of final follow-up. Increasing Tg after initial therapy was a significant risk factor for structural persistent disease in patients with BIR (HR, 4.16; 95% confidence interval (CI): 1.38–12.54, P = 0.011).
PTC patients with BIR showed a high rate of structural persistent disease and Tg change after initial therapy is the most important prognostic factor for determining clinical outcomes of these patients.
KeywordsPapillary thyroid carcinoma Prognosis Dynamic risk stratification Biochemical incomplete response
This study was supported by the National Research Foundation (NRF) of Korea Research Grant (NRF-2017R1D1A1B03028231).
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by J.A., E.S, and M.J.J. The first draft of the manuscript was written by J.A. and all authors commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the Institutional Review Board (IRB) of the Asan Medical Center. The IRB of the Asan Medical Center confirms that patient consent was not required for this retrospective study.
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