Treatment-Free Survival in Patients With Differentiated Thyroid Cancer

Abstract

Objective: Cancer recurrence is a primary concern for patients with differentiated thyroid cancer; however, population-level data on recurrent or persistent disease do not currently exist. The objective of this study was to determine treated recurrent or persistent thyroid cancer by using a population-based registry, identify correlates of poor treatment-free survival, and define prognostic groups for treatment-free survival.

Methods: In this population-based study, we evaluated treatment-free survival in 9273 patients from the Surveillance, Epidemiology, and End Results Program-Medicare with a diagnosis of differentiated thyroid cancer between 1998 and 2012. Treated recurrence was defined by treatment of recurrent or persistent differentiated thyroid cancer with surgery, radioactive iodine, or radiation therapy at ≥1 year after diagnosis. Multivariable analysis was performed with Cox proportional hazards regression, survival trees, and random survival forests.

Results: In this cohort the median patient age at time of diagnosis was 69 years, and 75% of the patients were female. Using survival tree analyses, we identified five distinct prognostic groups (P < 0.001), with a prediction accuracy of 88.7%. The 5-year treatment-free survival rates of these prognostic groups were 96%, 91%, 85%, 72%, and 52%, respectively, and the 10-year treatment-free survival rates were 94%, 87%, 80%, 64%, and 39%. Based on survival forest analysis, the most important factors for predicting treatment-free survival were stage, tumor size, and receipt of radioactive iodine.

Conclusion: In this population-based cohort, five prognostic groups for treatment-free survival were identified. Understanding treatment-free survival has implications for the care and long-term surveillance of patients with differentiated thyroid cancer.

Figure 1.

Treatment-free survival tree. 5yr, 5-year treatment-free survival; 10yr, 10-year treatment-free survival; N, total number of patients in the terminal group; R, treated recurrent or persistent disease; RAI, radioactive iodine.

Figure 2.

Relative importance of each patient, tumor, or treatment characteristic to treatment-free survival based on the random survival forest analysis. RAI, radioactive iodine.