Disease Free Survival of Well Differentiated Thyroid Cancer: 20 years Experience at a tertiary care center in Lebanon

  • Rita Hajj Boutros AUBMC
  • Asma Arabi
  • Mahmoud Shoucair
  • Jaber Abbas
  • Ibrahim Salti


Background: Thyroid cancer is the most common endocrine malignancy. Although relatively common, to date, there is no study about its prognosis in Lebanon. The objectives of this study were to determine the disease free survival, the recurrence rate and possible predictors of recurrence, as well as the rate of post thyroidectomy complications among patients with differentiated thyroid cancer who received treatment at the American University of Beirut Medical Center.

Methods and Findings: retrospective observational study of 480 cases of differentiated thyroid cancer who underwent thyroidectomy between January 1995 and June 2014. The mean age was 42±14 years. 74.4% were females. The mean tumor size was 1.9 cm±1.4. Papillary type was predominant (91%). Males had more extra-glandular extension than females (24.8% versus 10.9% respectively, p=0.001), more lymph node involvement (69.7% versus 52.9% respectively, p=0.017) and more vascular invasion (28.1% versus 14.9%, p=0.007). Around 70% of patients had at least one follow up visit after the surgery; among those, the median follow up duration was 4 years (1month-19years). At last follow-up visit, 78.7% were disease free, 14.9% had residual disease and only 6.3% had recurrent disease. By multivariate analysis, age greater than 45 years was the only independent predictor of persistence or recurrence (p=0.03) whereas both age below 45 years and lack of vascular invasion were significant predictors of disease free survival (p=0.001 and p=0.019 respectively).

Conclusion: Differentiated thyroid cancer has an overall good prognosis in this cohort of Lebanese patients. Young age and lack of vascular invasion are the most important predictors of disease free survival.


Key words: Differentiated thyroid cancer: disease free survival, prognostic factors, recurrence


1. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. J Am Med Assoc 2006;295(18):2164–2167.
2. Udelsman R, Zhang Y. The epidemic of thyroid cancer in the United States: the role of endocrinologists and ultrasounds. Thyroid 2014;24(3):472–479.
3. Leitzmann MF, Brenner A, Moore SC, et al. Prospective study of body mass index, physical activity and thyroid cancer. Int J Cancer. 2010;126:2947–2956.
4. Zhao G, Wang Z, Zhou H, Zhao Q. Burdens of PBBs, PBDEs, and PCBs in tissues of the cancer patients in the E-waste disassembly sites in Zhejiang, China. Sci Total Environ. 2009;407:4831–4837.
5. Carling T, Udelsman R. Thyroid cancer. Annu Rev Med 2014;65:125–137.
6. Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. 2012;118: 2338–2366.
7. Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167–1214.
8. Sanders LE, Cady B. Differentiated thyroid cancer: reexamination of risk groups and outcome of treatment. Arch Surg 1998;133(4):419–425.
9. Rossi RL, Cady B, Silverman ML, et al. Current results of conservative surgery for differentiated thyroid carcinoma. World J Surg 1986;10(4):612–622.
10. Sawka AM, Thephamongkhol K, Brouwers M, et al. Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab 2004;89(8):3668–3676.
11. Taylor T, Specker B, Robbins J, et al. Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Ann Intern Med 1998;129(8):622–627.
12. Mallick U, Harmer C, Yap B, et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N EnglJ Med 2012;366(18):1674–1685.
13. Schlumberger M, Catargi B, Borget I, et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 2012;366(18):1663–1673.
14. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994;97(5):418–428.
15. Dinneen SF, Valimaki MJ, Bergstralh EJ, et al. Distant metastases in papillary thyroid carcinoma: 100 cases observed at one institution during 5 decades. J Clin Endocrinol Metab 1995;80(7):2041–2045.
16. Samaan NA, Schultz PN, Haynie TP, et al. Pulmonary metastasis of differentiated thyroid carcinoma: treatment results in 101 patients. J Clin Endocrinol Metab 1985;60(2):376–380.
17. A.H. Lebastchi, G.G. Callender. Thyroid cancer. Current problems in cancer, 2014.
18. Loh KC.Familial non-medullary thyroid carcinoma: a meta-review of case series. Thyroid 1997.
19. Goldgar DE, EastonDF,Cannon-AlbrightLA, et al. Systematic population-based assessment of cancer risk in first-degree relatives ofcancer probands. J Natl Cancer Inst 1994.
20. 2015 ATA management guidelines for adult patients with thyroid nodules and DTC.
21. Cooper DS, Doherty GM, Haugen BR, et al:Revised American Thyroid Association management guidelines for patients with thyroid nodules and differenciated thyroid cancer. Thyroid 2009, 19:1167.
22. Mazzaferri EL, Jhiang SM: Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994, 97:418.
23. Palme CE, Waseem Z, Raza SN, et al. Management and outcome of recurrent well-differenciated thyroid carcinoma. Arch Otolaryngol Head neck Surg 2004, 130:819.
24. Mercante G, Frasoldati A, Pedroni C, et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 2009, 19:707.
25. Krausz Y, Uziely B, Karger H, et al: Recurrence-associated mortality in patients with differenciated thyroid carcinoma. J Surg Oncol 1993; 52: 164-168.
26. Ronga G, Filesi M, Montesano T, et al.: Death from differenciated thyroid carcinoma: Retrospective study of a 40-year investigation. Cancer Biother Radiopharm 2002; 17:507-514.
27. Ward LS, Souza SL, Assumpcao LV: The impact of nodal metastases on prognosis of well-differenciated thyroid cancer suggests the practice of prophylactic neck dissection. Arch Otolaryngol Head Neck Surg 2003; 129:495-496.
28. Filho JG, Kowalski LP. Postoperative Complications of Thyroidectomy for Differenciated Thyroid Carcinoma. American Journal of Otolaryngology, 2004.
How to Cite
HAJJ BOUTROS, Rita et al. Disease Free Survival of Well Differentiated Thyroid Cancer: 20 years Experience at a tertiary care center in Lebanon. International Archives of Medicine, [S.l.], v. 11, jan. 2018. ISSN 1755-7682. Available at: <http://imedicalpublisher.com/ojs/index.php/iam/article/view/2768>. Date accessed: 01 june 2023. doi: https://doi.org/10.3823/2545.