The outcomes and prognostic factors in patients after reoperation of persistent/recurrent papillary thyroid carcinoma

Abstract Background: The most suitable approach for the treatment of recurrent papillary thyroid carcinoma (PTC) remains controversial and reoperation may be an effective method. The efficacy of reoperation in these patients with locoregional recurrence, especially the ones with unsatisfying efficacy of radioactive iodine ablation, is still uncertain. This study aimed to clarify clinical management strategies for locoregional recurrence of PTC and to explore factors that may affect long-term patient outcomes after reoperation.Methods: In total, 124 patients who initially underwent thyroidectomy and variable extents of RAI therapy and finally received reoperation for locoregionally recurrent PTC, were included. Parameters associated with recurrence-free survival (RFS) were analyzed using a Cox proportional hazards model.Results: Thirty-two patients had secondary clinical recurrence after reoperation during follow-up. Metastatic lymph nodes with extra-nodal extension (P=0.023) and high post-reoperative (post-reop) unstimulated thyroglobulin (unstim-Tg) levels (P=0.001) were independent prognostic factors for recurrence-free survival. Neither the avidity of RAI nor the frequency and dose of RAI therapies before reoperation affected long-term outcome.Conclusions: Patients with locoregionally recurrent PTC rarely benefit from additional RAI therapy before reoperation, and surgical intervention should be prioritized in the clinical management of locoregionally recurrent PTC. Metastatic lymph nodes with extra-nodal extension and post-reop unstim-Tg >10.1 ng/mL may have a poor prognosis.