Clinical Aggressiveness and Long-Term Outcome in Patients with Papillary Thyroid Cancer and Circulating Anti-Thyroglobulin Autoantibodies

• DOI: 10.1089/thy.2013.0698
• Publication Date: 2014-04-04T17:15:18Z
• Authors: Cosimo Durante; Sara Tognini; Teresa Montesano; Fabio Orlandi; Massimo Torlontano; Efisio Puxeddu; Marco Attard; Giuseppe Costante; Salvatore Tumino; Domenico Meringolo; Rocco Bruno; Fabiana Trulli; Maria Toteda; Adriano Redler; Giuseppe Ronga; Sebastiano Filetti; Fabio Monzani
• Keywords: papillary thyroid cancer; anti-thyroglobulin autoantibodies.; Adult; Aged, 80 and over; Male; Adolescent; papillary thyroid carcinoma; anti-tg antibody; prognosis; Adolescent; Adult; Aged; Aged, 80 and over; Autoantibodies; Child; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Young Adult; Endocrinology, Diabetes and Metabolism; Endocrinology; Middle Aged; Prognosis; Thyroglobulin; thyroid neoplasia, papillary thyroid carcinoma, anti-thyroglobulin antibody, recurrences; 3. Good health; Young Adult; Thyroidectomy; Humans; Female; Thyroid Neoplasms; Neoplasm Recurrence, Local; Child; Aged; Autoantibodies; Retrospective Studies

The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis is widely recognized, but less is known about the possible link between circulating anti-thyroglobulin antibody (TgAb) titers and PTC aggressiveness. To shed light on this issue, we retrospectively examined a large series of PTC patients with and without positive TgAb.Data on 220 TgAb-positive PTC patients (study cohort) were retrospectively collected in 10 hospital-based referral centers. All the patients had undergone near-total thyroidectomy with or without radioiodine remnant ablation. Tumor characteristics and long-term outcomes (follow-up range: 2.5-24.8 years) were compared with those recently reported in 1020 TgAb-negative PTC patients with similar demographic characteristics. We also assessed the impact on clinical outcome of early titer disappearance in the TgAb-positive group.At baseline, the study cohort (mean age 45.9 years, range 12.5-84.1 years; 85% female) had a significantly higher prevalence of high-risk patients (6.9% vs. 3.2%, p<0.05) and extrathyroidal tumor extension (28.2% vs. 24%; p<0.0001) than TgAb-negative controls. Study cohort patients were also more likely than controls to have persistent disease at the 1-year visit (13.6% vs. 7.0%, p=0.001) or recurrence during subsequent follow-up (5.8% vs. 1.4%, p=0.0001). At the final follow-up visit, the percentage of patients with either persistent or recurrent disease in the two cohorts was significantly different (6.4% of TgAb-positive patients vs. 1.7% in the TgAb-negative group, p<0.0001). At the 1-year visit, titer normalization was observed in 85 of the 220 TgAb-positive individuals. These patients had a significantly lower rate of persistent disease than those who were still TgAb positive (8.2% vs. 17.3%. p=0.05), and no relapses were observed among patients with no evidence of disease during subsequent follow-up.PTC patients with positive serum TgAb titer during the first year after primary treatment were more likely to have persistent/recurrent disease than those who were consistently TgAb-negative. Negative titers at 1 year may be associated with more favorable outcomes.