Palabras clave
cáncer de Tiroides
recurrencia
recaída
tiroglobulina
ganglios linfáticos
recurrencia
recaída
tiroglobulina
ganglios linfáticos
Cómo citar
Marin, L. F., Torres, J. L., Wandurraga, E. A., Aristizabal, C., Aristizabal, N., Sylva, D. I., Ospina, D. C., Dueñas, J. P., Natera, A. K., Gómez, C. M., Rondón, M. A., & Serrano-Gómez, S. E. (2019). Predictores de recaída en carcinoma diferenciado de tiroides en Colombia: estudio multicéntrico. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(2), 92–100. https://doi.org/10.53853/encr.6.2.483
Resumen
Introducción: El cáncer diferenciado de tiroides es una enfermedad que si bien no tiene una tasa alta de mortalidad, acarrea una carga de morbilidad importante dada principalmente por la recurrencia. Nuestro objetivo fue determinar los factores asociados a recaída en pacientes de tres centros de referencia en Colombia.
Métodos: Se realizó un estudio descriptivo retrospectivo. Las variables demográficas, clínicas e histopatológicas fueron recolectadas a partir de las historias clínicas de pacientes atendidos durante tres años.
Resultados: Fueron incluidos 481 sujetos. El 85,7% eran mujeres y el 59,3% de la población fue mayor de 45 años. En el 97% de los casos se trató de carcinoma papilar. El promedio de seguimiento fue de 5,1±4,9 años. La recaída tumoral se documentó en el 16,8% de los sujetos con una mediana de tiempo de tres años desde la terapia inicial. Se encontró asociación entre recaída y el tamaño del tumor, extensión extratiroidea, relación ganglios comprometidos/resecados centrales y totales y compromiso periganglionar en el análisis univariado. El número de ganglios totales comprometidos ? 2 (HR 4,10, IC 95% 1,07 - 4,85) y el valor de tiroglobulina estimulada ? 7,29 ng/ml (HR 2,28, IC 95% 1,07-4,85, p=0,031) fueron los dos factores independientes asociados con recaída en el análisis multivariado.
Conclusiones: Los pacientes con cáncer diferenciado de tiroides con compromiso metastásico de hasta un ganglio cervical y/o un nivel de tiroglobulina preablativa inferior a 7,29 ng/ml pueden ser considerados de bajo riesgo para recaída.
Citas
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13. Thyroid. 2018 Oct;28(10):1311-1317Toubeau M, Touzery C, Arveux P, Chaplain G, Vaillant G, Berriolo A, et al. Predictive value for disease progression of serum thyroglobulin levels mesured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 2004 Jun;45(6):988-94.
14. Bernier MO, Morel O, Rodien P, Muratet JP, Giraud P, Rohmer V, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2005 Dec;32(12):1418-21.
15. Giovanella L, Ceriani L, Ghelfo A, Keller F. Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in low-risk papillary thyroid carcinoma. Clin Chem Lab Med. 2005;43(8):843-7.
16. Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, et al. Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2005 Mar;90(3):1440-5.
17. Heemstra KA, Liu YY, Stokke lM, Kievit J, Corssmit E, Pereira, et al. Serum thyroglobulin concentration predicts disease-free remission and death in differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2007; 66:58-64 .
18. Familiar C, Moraga I, Antón T, Gargallo MA, Ramos A, Marco AL, et al. Risk factors of persistent disease at 5 years from diagnosis indifferentiated thyroid cancer: study of 63 patients. Endocrinol Nutr. 2009;56:361-368.
19. Pelttari H, Valimaki MJ, Loyttyniemi E, Schalin-Jantti C. Postablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up study. Eur J Endocrinol. 2010; 163:757-763.
20. Rosario PW, Xavier AC, Calsolari MR. Value of postoperative thyroglobulin and ultrasonography for the indication of ablation and 131I activity in patients with thyroid cancer and low risk of recurrence. Thyroid. Jan;21(1):49-53.
21. Polachek A, Hirsch D, Tzvetov G, Grozinsky-Glasberg S, Slutski I, Singer J, et al. Prognostic value of post-thyroidectomy thyroglobulin levels in patients with differentiated thyroid cancer. J Endocrinol Invest 2011; 34:855-860.
22. Webb R, Howard RS, Sojadinovic A, Burch HB. Post-operative thyroglobulin: significant marker of persistent or recurrent papillary thyroid cancer. Society of Surgical Oncology 63rd Annual Cancer Symposium, St. Louis, MO, 2010 (Abstract P84).
23. Webb R, Howard RS, Stojadinovic A, Gaitonde D, Wallace MK, Ahmed J et al. The Utility of Serum Thyroglobulin Measurement at the Time of Remnant Ablation for Predicting DiseaseFree Status in Patients with Differentiated Thyroid Cancer: A Meta-Analysis Involving 3947 Patient. J Clin Endocrin Metab. 2012 ; 97(8): 2754-2763.
24. Lee SG, Ho J, Choi JB, Kim TH, Kim MJ, Ban EJ. Optimal Cut-Off Values of Lymph Node Ratio Predicting Recurrence in Papillary Thyroid Cancer. Medicine (Baltimore). 2016 Feb;95(5):e2692.
25. Wu MH, Shen WT, Gosnell J, Duh QY. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck. 2015 Sep;37(9):1336-43.
2. Yoo JY, Stang MT. Current guidelines for Postoperative Treatment and Follow – Up of Well – Differentiated Thyroid Cancer. Surg Oncol Clin N Am 2016;25:41-59.
3. Goyal R, Jonklaas J, Burman K. Management of Recurrent Cervical Papillary Thyroid Cancer. Endocrinol Metab Clin N Am 2014;43:565-572.
4. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cáncer. Thyroid 2016 Jan;26(1):1-133.
5. Garavito G. Factores pronósticos para recaída en pacientes con cáncer papilar de tiroides. Rev Colomb. Cancerol 2005;9(2):21-20.
6. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 2012 Nov;22(11):1144-52.
7. Hwangbo Y, Kim JM, Park YJ, Lee EK, Lee YJ, Park DJ, et al. Long-Term Recurrence of Small Papillary Thyroid Cancer and Its Risk Factors in a Korean Multicenter Study. J Clin Endocrinol Metab. 2017 Feb 1;102(2):625-633.
8. Lee J, Song Y, Soh EY. Prognostic significance of the number of metastatic lymph nodes to stratify the risk of recurrence. World J Surg. 2014 Apr;38(4):858-62.
9. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 2004 Feb;135(2):139-48.
10. Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 2005 Oct;90(10):5723-9.
11. Ito Y, Jikuzono T, Higashiyama T, Asahi S, Tomoda C, Takamura Y, et al. Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe. World J Surg 2006 Oct;30(10):1821-8.
12. Llamas-Olier AE, Cuéllar DI, Buitrago G. Intermediate-Risk Papillary Thyroid Cancer: Risk Factors for Early Recurrence in Patients with Excellent Response to Initial Therapy. Thyroid. 2018 Oct;28(10):1311-1317.
13. Thyroid. 2018 Oct;28(10):1311-1317Toubeau M, Touzery C, Arveux P, Chaplain G, Vaillant G, Berriolo A, et al. Predictive value for disease progression of serum thyroglobulin levels mesured in the postoperative period and after (131)I ablation therapy in patients with differentiated thyroid cancer. J Nucl Med. 2004 Jun;45(6):988-94.
14. Bernier MO, Morel O, Rodien P, Muratet JP, Giraud P, Rohmer V, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2005 Dec;32(12):1418-21.
15. Giovanella L, Ceriani L, Ghelfo A, Keller F. Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in low-risk papillary thyroid carcinoma. Clin Chem Lab Med. 2005;43(8):843-7.
16. Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, et al. Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2005 Mar;90(3):1440-5.
17. Heemstra KA, Liu YY, Stokke lM, Kievit J, Corssmit E, Pereira, et al. Serum thyroglobulin concentration predicts disease-free remission and death in differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2007; 66:58-64 .
18. Familiar C, Moraga I, Antón T, Gargallo MA, Ramos A, Marco AL, et al. Risk factors of persistent disease at 5 years from diagnosis indifferentiated thyroid cancer: study of 63 patients. Endocrinol Nutr. 2009;56:361-368.
19. Pelttari H, Valimaki MJ, Loyttyniemi E, Schalin-Jantti C. Postablative serum thyroglobulin is an independent predictor of recurrence in low-risk differentiated thyroid carcinoma: a 16-year follow-up study. Eur J Endocrinol. 2010; 163:757-763.
20. Rosario PW, Xavier AC, Calsolari MR. Value of postoperative thyroglobulin and ultrasonography for the indication of ablation and 131I activity in patients with thyroid cancer and low risk of recurrence. Thyroid. Jan;21(1):49-53.
21. Polachek A, Hirsch D, Tzvetov G, Grozinsky-Glasberg S, Slutski I, Singer J, et al. Prognostic value of post-thyroidectomy thyroglobulin levels in patients with differentiated thyroid cancer. J Endocrinol Invest 2011; 34:855-860.
22. Webb R, Howard RS, Sojadinovic A, Burch HB. Post-operative thyroglobulin: significant marker of persistent or recurrent papillary thyroid cancer. Society of Surgical Oncology 63rd Annual Cancer Symposium, St. Louis, MO, 2010 (Abstract P84).
23. Webb R, Howard RS, Stojadinovic A, Gaitonde D, Wallace MK, Ahmed J et al. The Utility of Serum Thyroglobulin Measurement at the Time of Remnant Ablation for Predicting DiseaseFree Status in Patients with Differentiated Thyroid Cancer: A Meta-Analysis Involving 3947 Patient. J Clin Endocrin Metab. 2012 ; 97(8): 2754-2763.
24. Lee SG, Ho J, Choi JB, Kim TH, Kim MJ, Ban EJ. Optimal Cut-Off Values of Lymph Node Ratio Predicting Recurrence in Papillary Thyroid Cancer. Medicine (Baltimore). 2016 Feb;95(5):e2692.
25. Wu MH, Shen WT, Gosnell J, Duh QY. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer. Head Neck. 2015 Sep;37(9):1336-43.
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