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Paper 14 (0815)
RADIOACTIVE IODINE OFFERS SURVIVAL IMPROVEMENT IN PATIENTS WITH FOLLICULAR CARCINOMA OF THE THYROID
Background: The adjuvant use of radioactive Iodine in patients with follicular thyroid carcinoma is well established. How its use affects patient outcome and in which patients the greatest benefit is achieved is poorly understood. This study seeks to determine how the use of radioactive Iodine influences patient survival and delineate which patient populations are most impacted.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
Yale Podnos MD, MPH, David Smith PhD, Lawrence Wagman MD, and Joshua Ellenhorn MD.
City of Hope National Medical Center, Duarte, CA.
Methods: The Surveillance, Epidemiology, and End Results: (SEER) database is a large-scale sample of approximately 14% of the US population. It was used to identify patients with follicular thyroid carcinomas and the treatment they received. Factors such as presence of lymph node and distant metastases, age, and tumor size, were included in a multivariate and chi squared analysis.
Results: A total of 4317 patients were identified from the SEER database with follicular thyroid carcinoma. Median follow up was 114 months. Multivariate analysis identified older patients, those with distant metastatic disease, or larger tumors as having a worse prognosis. Additionally, lymph node involvement was associated with a risk ratio of 1.94 (95% CI 1.47 - 2.50). The use of radioactive Iodine ameliorated outcome (p=0.03) and the lack of radioisotope use significantly increased risk of death (relative risk 1.24, 95% CI 1.06-1.51). On subset analysis, low risk patients under age 45 years with primary tumors <2cm and no lymph node or metastatic disease did not benefit from radioactive Iodine.
Conclusions: Radioactive Iodine provides survival benefit to patients with follicular carcinoma of the thyroid. However, low risk patients derive no survival benefit from adjuvant RAI.