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Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy

2012; Wiley; Volume: 77; Issue: 1 Linguagem: Inglês

10.1111/j.1365-2265.2012.04342.x

1365-2265

Fernanda Vaisman, Denise Momesso, Daniel Bulzico, Cencita H. C. N. Pessoa, Fernando Luiz Dias, Rossana Corbo, Mário Vaisman, R. Michael Tuttle,

BRCA gene mutations in cancer

Summary Objective To validate the A merican T hyroid A ssociation ( ATA ) initial risk of recurrence scheme and the M emorial S loan K ettering C ancer C enter ( MSKCC ) response to therapy re‐stratification approach in a large cohort of patients with differentiated thyroid cancer ( DTC ) treated outside of the U nited S tates. Design Retrospective chart review. Patients Five hundred and six patients with DTC followed for a median of 10 years after total thyroidectomy and RAI remnant ablation at a major cancer centre in B razil. Measurements Final clinical outcomes were assessed based on A merican J oint C ancer C ommittee ( AJCC )/ U nion I nternationale C ontre le C ancer ( UICC ) staging, ATA risk stratification and response to therapy assessment (excellent, acceptable, biochemical incomplete and structural incomplete). Results The AJCC / UICC staging system did not adequately stratify patients with regard to the risk of recurrence/persistent disease. However, the ATA system demonstrated a 13% risk of recurrent/persistent disease in low‐risk patients, 36% in intermediate risk patients, and 68% in high‐risk patients. Furthermore, an excellent response to therapy decreased the risk of recurrent/persistent disease to 1·4%. At the time of final follow‐up, 34% of the biochemical incomplete response patients had been re‐classified as having no evidence of disease ( NED ) without having received any additional therapy beyond continue levothyroxine suppression. Conversely, even after additional therapies, only 9% of the patients with an incomplete structural response were eventually re‐classified as NED . Conclusions These data validate the ATA risk classification as an excellent initial predictor of recurrent/persistent disease and confirm the clinical utility of the MSKCC dynamic risk assessment system in a cohort of patients evaluated and treated outside the U nited S tates.