Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma

Terry Taylor, Bonny Specker, Jacob Robbins, Matthew Sperling, Mona Ho, Kenneth Ain, S. Thomas Bigos, Jim Brierley, David Cooper, Bryan Haugen, Ian D Hay, Vicki Hertzberg, Irwin Klein, Herbert Klein, Paul Ladenson, Ronald Nishiyama, Douglas Ross, Steven Sherman, Harry R. Maxon

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Abstract

Background: Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial. Objective: To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high- risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Design: Analysis of data from a multicenter study. Setting: 14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry. Patients: 385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma). Measurements: Death, disease progression, and disease-free survival. Results: Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine- 131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease- free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival. Conclusions: This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.

Original languageEnglish (US)
Pages (from-to)622-627
Number of pages6
JournalAnnals of Internal Medicine
Volume129
Issue number8
StatePublished - Oct 15 1998

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Follicular Adenocarcinoma
Disease-Free Survival
Odds Ratio
Neoplasms
Thyroid Neoplasms
Mortality
Radiotherapy
Therapeutics
Papillary Carcinoma
Thyroidectomy
Iodine
Carcinoma
Survival

ASJC Scopus subject areas

  • Medicine(all)

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Taylor, T., Specker, B., Robbins, J., Sperling, M., Ho, M., Ain, K., ... Maxon, H. R. (1998). Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Annals of Internal Medicine, 129(8), 622-627.

Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. / Taylor, Terry; Specker, Bonny; Robbins, Jacob; Sperling, Matthew; Ho, Mona; Ain, Kenneth; Bigos, S. Thomas; Brierley, Jim; Cooper, David; Haugen, Bryan; Hay, Ian D; Hertzberg, Vicki; Klein, Irwin; Klein, Herbert; Ladenson, Paul; Nishiyama, Ronald; Ross, Douglas; Sherman, Steven; Maxon, Harry R.

In: Annals of Internal Medicine, Vol. 129, No. 8, 15.10.1998, p. 622-627.

Research output: Contribution to journalArticle

Taylor, T, Specker, B, Robbins, J, Sperling, M, Ho, M, Ain, K, Bigos, ST, Brierley, J, Cooper, D, Haugen, B, Hay, ID, Hertzberg, V, Klein, I, Klein, H, Ladenson, P, Nishiyama, R, Ross, D, Sherman, S & Maxon, HR 1998, 'Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma', Annals of Internal Medicine, vol. 129, no. 8, pp. 622-627.
Taylor T, Specker B, Robbins J, Sperling M, Ho M, Ain K et al. Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Annals of Internal Medicine. 1998 Oct 15;129(8):622-627.
Taylor, Terry ; Specker, Bonny ; Robbins, Jacob ; Sperling, Matthew ; Ho, Mona ; Ain, Kenneth ; Bigos, S. Thomas ; Brierley, Jim ; Cooper, David ; Haugen, Bryan ; Hay, Ian D ; Hertzberg, Vicki ; Klein, Irwin ; Klein, Herbert ; Ladenson, Paul ; Nishiyama, Ronald ; Ross, Douglas ; Sherman, Steven ; Maxon, Harry R. / Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. In: Annals of Internal Medicine. 1998 ; Vol. 129, No. 8. pp. 622-627.
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title = "Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma",
abstract = "Background: Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial. Objective: To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high- risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Design: Analysis of data from a multicenter study. Setting: 14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry. Patients: 385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma). Measurements: Death, disease progression, and disease-free survival. Results: Total or near-total thyroidectomy was done in 85.3{\%} of patients with papillary carcinoma and 71.3{\%} of patients with follicular cancer. Overall surgical complication rate was 14.3{\%}. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95{\%} CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine- 131 was given to 85.4{\%} of patients with papillary cancer and 79.3{\%} of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease- free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5{\%} of patients and was not associated with improved survival, lack of progression, or disease-free survival. Conclusions: This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.",
author = "Terry Taylor and Bonny Specker and Jacob Robbins and Matthew Sperling and Mona Ho and Kenneth Ain and Bigos, {S. Thomas} and Jim Brierley and David Cooper and Bryan Haugen and Hay, {Ian D} and Vicki Hertzberg and Irwin Klein and Herbert Klein and Paul Ladenson and Ronald Nishiyama and Douglas Ross and Steven Sherman and Maxon, {Harry R.}",
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T1 - Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma

AU - Taylor, Terry

AU - Specker, Bonny

AU - Robbins, Jacob

AU - Sperling, Matthew

AU - Ho, Mona

AU - Ain, Kenneth

AU - Bigos, S. Thomas

AU - Brierley, Jim

AU - Cooper, David

AU - Haugen, Bryan

AU - Hay, Ian D

AU - Hertzberg, Vicki

AU - Klein, Irwin

AU - Klein, Herbert

AU - Ladenson, Paul

AU - Nishiyama, Ronald

AU - Ross, Douglas

AU - Sherman, Steven

AU - Maxon, Harry R.

PY - 1998/10/15

Y1 - 1998/10/15

N2 - Background: Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial. Objective: To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high- risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Design: Analysis of data from a multicenter study. Setting: 14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry. Patients: 385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma). Measurements: Death, disease progression, and disease-free survival. Results: Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine- 131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease- free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival. Conclusions: This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.

AB - Background: Treatment of differentiated thyroid cancer has been studied for many years, but the benefits of extensive initial thyroid surgery and the addition of radioiodine therapy or external radiation therapy remain controversial. Objective: To determine the relations among extent of surgery, radioiodine therapy, and external radiation therapy in the treatment of high- risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Design: Analysis of data from a multicenter study. Setting: 14 institutions in the United States and Canada participating in the National Thyroid Cancer Treatment Cooperative Study Registry. Patients: 385 patients with high-risk thyroid cancer (303 with papillary carcinoma and 82 with follicular carcinoma). Measurements: Death, disease progression, and disease-free survival. Results: Total or near-total thyroidectomy was done in 85.3% of patients with papillary carcinoma and 71.3% of patients with follicular cancer. Overall surgical complication rate was 14.3%. Total or near-total thyroidectomy improved overall survival (risk ratio [RR], 0.37 [95% CI, 0.18 to 0.75]) but not cancer-specific mortality, progression, or disease-free survival in patients with papillary cancer. No effect of extent of surgery was seen in patients with follicular thyroid cancer. Postoperative iodine- 131 was given to 85.4% of patients with papillary cancer and 79.3% of patients with follicular cancer. In patients with papillary cancer, radioiodine therapy was associated with improvement in cancer-specific mortality (RR, 0.30 [CI, 0.09 to 0.93 by multivariate analysis only]) and progression (RR, 0.30 [CI, 0.13 to 0.72]). When tall-cell variants were excluded, the effect on outcome was not significant. After radioiodine therapy, patients with follicular thyroid cancer had improvement in overall mortality (RR, 0.17 [CI, 0.06 to 0.47]), cancer-specific mortality (RR, 0.12 [CI, 0.04 to 0.42]), progression (RR, 0.21 [CI, 0.08 to 0.56]), and disease- free survival (RR, 0.29 [CI, 0.08 to 1.01]). External radiation therapy to the neck was given to 18.5% of patients and was not associated with improved survival, lack of progression, or disease-free survival. Conclusions: This study supports improvement in overall and cancer-specific mortality among patients with papillary and follicular thyroid cancer after postoperative iodine-131 therapy. Radioiodine therapy was also associated with improvement in progression in patients with papillary cancer and improvement in progression and disease-free survival in patients with follicular carcinoma.

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