Determinants of Worsening Response to Therapy in Patients Diagnosed With Papillary Thyroid Carcinoma in a Tertiary Hospital
Megan Margrethe D. Balina, Elaine C. Cunanan, Erick S. Mendoza, Bien J. Matawaran, Sjoberg A. Kho
Apr 2025 DOI 10.35460/2546-1621.2024-0171 Access

Abstract
Introduction: Papillary thyroid cancer (PTC) is generally considered to be an indolent disease with relatively good prognosis. However, some studies have shown that the Filipino population has a higher risk for disease recurrence compared to non-Filipino patients and hence early identification and management during the follow-up period would be beneficial, especially those in whom risk factors for recurrence were identified.
Objective. This study aims to identify determinants for disease recurrence of patients with papillary thyroid carcinoma (as defined by the American Thyroid Association (ATA) guidelines 2015) diagnosed from January 1, 2013-December 31, 2017, seen at the University of Santo Tomas Hospital (USTH) outpatient endocrine clinic and underwent total thyroidectomy with or without radioactive iodine ablation therapy.
Methodology: Retrospective review of outpatient medical records of 82 patients with PTC who underwent total thyroidectomy with or without radioactive iodine (RAI) therapy and achieved excellent response (ER) to therapy was performed. Baseline clinical profile such as age at diagnosis, sex, family history of thyroid cancer, family history of goiter, histopathology result, serial thyroglobulin (Tg), anti-thyroglobulin (anti-Tg) levels, whole body scan reports, neck ultrasound reports and RAI doses were collected. Logistic regression analysis was used to identify determinants to the development of worsening response.
Results: Of the 82 patients, 18 (21.9%) developed worsening response to therapy. Predictors of poor outcomes identified from previous studies such as age, sex, extent of disease, size and multifocality of tumors, ATA risk classification and initial dynamic risk assessment, RAI therapy, level of thyroid-stimulating hormone (TSH) suppression were analyzed. After logistic regression analysis, there was no significant association between variables and progression to worsening response that were previously identified in other studies.
Conclusion: Even though no significant association between investigated variables and worsening response were identified in this study, previous studies with larger populations that had exhibited positive association should be considered and hence current Philippine guidelines for the management of PTC must still be applied.
Keywords: Thyroid cancer, papillary thyroid carcinoma, excellent response, disease recurrence
- Lo TEN, Uy AT, Maningat PDD. Well-differentiated thyroid cancer: The Philippine general hospital experience. Endocrinol Metab (Seoul) [Internet]. 2016;31(1):72–9. Available from: http://dx.doi.org/10.3803/EnM.2016.31.1.72
- Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: Is there added morbidity? Surgery [Internet]. 2009;145(5):514–8. Available from: http://dx.doi.org/10.1016/j.surg.2009.01.013
- Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA [Internet]. 2006;295(18):2164–7. Available from: http://dx.doi.org/10.1001/jama.295.18.2164
- Jauculan MCM, Buenaluz-Sedurante M, Jimeno CA. Risk factors associated with disease recurrence among patients with low-risk papillary thyroid cancer treated at the University of the Philippines-Philippine General Hospital. Endocrinol Metab (Seoul) [Internet]. 2016;31(1):113–9. Available from: http://dx.doi.org/10.3803/EnM.2016.31.1.113
- Kus LH, Shah M, Eski S, Walfish PG, Freeman JL. Thyroid cancer outcomes in Filipino patients. Arch Otolaryngol Head Neck Surg [Internet]. 2010;136(2):138–42. Available from: http://dx.doi.org/10.1001/archoto.2009.206
- Sison CM, Obaldo J, Matsuo J, Uy GL, Jaring C. University of the Philippines – Philippine general hospital revised clinical practice guidelines for the management of well-differentiated thyroid carcinoma of follicular cell origin. J ASEAN Fed Endocr Soc [Internet]. 2012;27(1):49–61. Available from: http://dx.doi.org/10.15605/jafes.027.01.08
- 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 cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid [Internet]. 2016;26(1):1–133. Available from: http://dx.doi.org/10.1089/thy.2015.0020
- Santiago AG, Isidro MJ, Parra J. Predictors of response to therapy among post thyroidectomy adult Filipino patients with papillary thyroid carcinoma based on the 2015 American thyroid association guidelines. J ASEAN Fed Endocr Soc [Internet]. 2021;36(2):161–6. Available from: http://dx.doi.org/10.15605/jafes.036.02.18
- Mendoza ES. 2021 Philippine interim clinical practice guidelines (CPG) for the diagnosis and management of well-differentiated thyroid cancer [Internet]. Philippine College of Endocrinology Diabetes and Metabolism. 2022 [cited 2024]. Available from: https://endo-society.org.ph/2021-philippine-interim-clinical-practice-guidelines-cpg-for-the-diagnosis-and-management-of-well-differentiated-thyroid-cancer/
- Sun J-H, Li Y-R, Chang K-H, Liou M-J, Lin S-F, Tsai S-S, et al. Evaluation of recurrence risk in patients with papillary thyroid cancer through tumor-node-metastasis staging: A single-center observational study in Taiwan. Biomed J [Internet]. 2022;45(6):923–30. Available from: http://dx.doi.org/10.1016/j.bj.2021.11.009
- Albano D, Bellini P, Dondi F, Calabrò A, Casella C, Taboni S, et al. Temporal evolution and prognostic role of indeterminate response sub-groups in patients with differentiated thyroid cancer after initial therapy with radioiodine. Cancers (Basel) [Internet]. 2023;15(4). Available from: http://dx.doi.org/10.3390/cancers15041270
- Mendoza ES, Lopez AA, Valdez VAU, Cunanan EC, Matawaran BJ, Kho SA, et al. Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital. J Endocrinol Invest [Internet]. 2016;39(1):55–62. Available from: http://dx.doi.org/10.1007/s40618-015-0319-2
- Morita SY, Grace CK, Lum CA, Davis JW. Abstract B76: Thyroid cancer ethnic disparity in Hawaii: BRAF mutation within the Filipino population. Cancer Epidemiol Biomarkers Prev [Internet]. 2011;20(10_Supplement):B76–B76. Available from: http://dx.doi.org/10.1158/1055-9965.disp-11-b76
- Espiritu GAM, Malana JT, Dumasis AJGV, Ang DC. High preponderance of BRAF V600E mutation in papillary thyroid carcinoma among Filipinos: A clinicopathologic study. J Glob Oncol [Internet]. 2019;5(5):1–6. Available from: http://dx.doi.org/10.1200/JGO.18.00085
- Ghaznavi SA, Ganly I, Shaha AR, English C, Wills J, Tuttle RM. Using the American thyroid association risk-stratification system to refine and individualize the American Joint Committee on cancer eighth edition disease-specific survival estimates in differentiated thyroid cancer. Thyroid [Internet]. 2018;28(10):1293–300. Available from: http://dx.doi.org/10.1089/thy.2018.0186
- Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid [Internet]. 2010;20(12):1341–9. Available from: http://dx.doi.org/10.1089/thy.2010.0178
- Differential expression patterns and clinical significance of estrogen receptor- α and - β in papillary thyroid carcinoma. BMC Cancer. 2014;14.
- Immunohistochemical expression of estrogen receptor- α and progesterone receptor in patients with papillary thyroid cancer. Eur Thyroid J. 2016;5:224–30.
- Durante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, et al. Papillary thyroid cancer: time course of recurrences during postsurgery surveillance. J Clin Endocrinol Metab [Internet]. 2013;98(2):636–42. Available from: http://dx.doi.org/10.1210/jc.2012-3401
- Xiang Y, Xu Y, Bhandari A, Sindan N, Hirachan S, Yang Q, et al. Serum TSH levels are associated with postoperative recurrence and lymph node metastasis of papillary thyroid carcinoma. Am J Transl Res. 2021;13(6):6108–16.
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