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Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer.

Publication ,  Journal Article
Ruel, E; Thomas, S; Dinan, M; Perkins, JM; Roman, SA; Sosa, JA
Published in: J Clin Endocrinol Metab
April 2015

CONTEXT: Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients. OBJECTIVE: The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients. DESIGN/SETTING: Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study. PATIENTS: Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded. MAIN OUTCOME MEASURES: Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured. RESULTS: A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs 128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016). CONCLUSION: This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.

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Published In

J Clin Endocrinol Metab

DOI

EISSN

1945-7197

Publication Date

April 2015

Volume

100

Issue

4

Start / End Page

1529 / 1536

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Thyroid Neoplasms
  • Thyroid Cancer, Papillary
  • Survival Analysis
  • Severity of Illness Index
  • Recurrence
  • Radiotherapy, Adjuvant
  • Middle Aged
  • Male
  • Iodine Radioisotopes
 

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Ruel, E., Thomas, S., Dinan, M., Perkins, J. M., Roman, S. A., & Sosa, J. A. (2015). Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab, 100(4), 1529–1536. https://doi.org/10.1210/jc.2014-4332
Ruel, Ewa, Samantha Thomas, Michaela Dinan, Jennifer M. Perkins, Sanziana A. Roman, and Julie Ann Sosa. “Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer.J Clin Endocrinol Metab 100, no. 4 (April 2015): 1529–36. https://doi.org/10.1210/jc.2014-4332.
Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab. 2015 Apr;100(4):1529–36.
Ruel, Ewa, et al. “Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer.J Clin Endocrinol Metab, vol. 100, no. 4, Apr. 2015, pp. 1529–36. Pubmed, doi:10.1210/jc.2014-4332.
Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab. 2015 Apr;100(4):1529–1536.
Journal cover image

Published In

J Clin Endocrinol Metab

DOI

EISSN

1945-7197

Publication Date

April 2015

Volume

100

Issue

4

Start / End Page

1529 / 1536

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Thyroid Neoplasms
  • Thyroid Cancer, Papillary
  • Survival Analysis
  • Severity of Illness Index
  • Recurrence
  • Radiotherapy, Adjuvant
  • Middle Aged
  • Male
  • Iodine Radioisotopes