Yul Hwangbo1,2, Jung Min Kim3, Young Joo Park2, Eun Kyung Lee1, You Jin Lee1, Do Joon Park2, Young Sik Choi4, Kang Dae Lee5, Seo Young Sohn6, Sun Wook Kim6, Jae Hoon Chung6, Dong Jun Lim7, Min Hee Kim7, Min Joo Kim3, Young Suk Jo8, Min Ho Shong8, Sung-Soo Koong9, Jong Ryeal Hahm10, Jung Hwa Jung10, Ka Hee Yi2,11. 1. Center for Thyroid Cancer, National Cancer Center, Goyang 10408, Republic of Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea. 3. Department of Internal Medicine, Korea Cancer Center Hospital, Seoul 01812, Republic of Korea; Departments of. 4. Internal Medicine and. 5. Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan 49267, Republic of Korea. 6. Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea. 7. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul 06591, Republic of Korea. 8. Department of Internal Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea. 9. Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea. 10. Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; and. 11. Department of Internal Medicine, Seoul Natinal University Boramae Medical Center, Seoul 07061, Republic of Korea.
Abstract
Context: Small papillary thyroid cancer (PTC) generally has an excellent prognosis. However, long-term recurrence is not uncommon and sometimes leads to morbidity or mortality. Objective: To identify high-risk factors for long-term recurrence in patients with small PTC by stratifying their pathologic characteristics. Design, Setting, and Patients: We conducted a nationwide, retrospective, multicenter study of 3282 patients with PTC sized ≤2 cm from 9 high-volume hospitals in Korea. Main Outcome Measures: The maximally selected χ2 method was used to find the best cutoff points of tumor size, the number of metastatic lymph nodes (LNs), and the ratio of metastatic/examined LNs (LNR) to predict recurrence. Kaplan-Meier analysis and the Cox proportional hazards regression model were used to analyze recurrence and risk factors. Results: The optimal tumor size cutoff was 1.8 cm (10-year recurrence rates for tumors sized 0.1 to 1.7 cm and 1.8 to 2.0 cm: 7.7% vs 17.2%, respectively). Metastatic LNs ≤1 and ≥2 provided optimal estimates of recurrence (10-year recurrence rates: 4.0% vs 16.8%, respectively). The LNR of 0.19 was the optimal cutoff point for predicting the risk of recurrence (10-year recurrence rates for LNRs of 0 to 0.18 and 0.19 to 1: 2.7% vs 16.2%, respectively). LN metastasis, lobectomy, tumor size ≥1.8 cm, and bilateral tumors were independent risk factors for recurrence. Conclusions: Long-term recurrence was increased in patients who underwent lobectomy or with tumor sized ≥1.8 cm, 2 or more metastatic LNs, or bilateral tumors. For patients with these high-risk features, total thyroidectomy could be considered to avoid reoperation.
Context:Small papillary thyroid cancer (PTC) generally has an excellent prognosis. However, long-term recurrence is not uncommon and sometimes leads to morbidity or mortality. Objective: To identify high-risk factors for long-term recurrence in patients with small PTC by stratifying their pathologic characteristics. Design, Setting, and Patients: We conducted a nationwide, retrospective, multicenter study of 3282 patients with PTC sized ≤2 cm from 9 high-volume hospitals in Korea. Main Outcome Measures: The maximally selected χ2 method was used to find the best cutoff points of tumor size, the number of metastatic lymph nodes (LNs), and the ratio of metastatic/examined LNs (LNR) to predict recurrence. Kaplan-Meier analysis and the Cox proportional hazards regression model were used to analyze recurrence and risk factors. Results: The optimal tumor size cutoff was 1.8 cm (10-year recurrence rates for tumors sized 0.1 to 1.7 cm and 1.8 to 2.0 cm: 7.7% vs 17.2%, respectively). Metastatic LNs ≤1 and ≥2 provided optimal estimates of recurrence (10-year recurrence rates: 4.0% vs 16.8%, respectively). The LNR of 0.19 was the optimal cutoff point for predicting the risk of recurrence (10-year recurrence rates for LNRs of 0 to 0.18 and 0.19 to 1: 2.7% vs 16.2%, respectively). LN metastasis, lobectomy, tumor size ≥1.8 cm, and bilateral tumors were independent risk factors for recurrence. Conclusions: Long-term recurrence was increased in patients who underwent lobectomy or with tumor sized ≥1.8 cm, 2 or more metastatic LNs, or bilateral tumors. For patients with these high-risk features, total thyroidectomy could be considered to avoid reoperation.
Authors: Samuel Chan; Katarina Karamali; Anna Kolodziejczyk; Georgios Oikonomou; John Watkinson; Vinidh Paleri; Iain Nixon; Dae Kim Journal: Eur Thyroid J Date: 2020-01-28
Authors: Min Jhi Kim; Seul Gi Lee; Kwangsoon Kim; Cho Rok Lee; Sang-Wook Kang; Jandee Lee; Kee-Hyun Nam; Woong Youn Chung; Jong Ju Jeong Journal: Medicine (Baltimore) Date: 2019-05 Impact factor: 1.817