Matthieu Bosset1, Maxime Bonjour2, Solène Castellnou1, Zakia Hafdi-Nejjari3, Claire Bournaud-Salinas4, Myriam Decaussin-Petrucci5, Jean Christophe Lifante6,7, Agnès Perrin1, Jean-Louis Peix6, Philippe Moulin1,8, Geneviève Sassolas3, Michel Pugeat1, Françoise Borson-Chazot1,3,7. 1. Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France. 2. Service de Biostatistique, Hospices Civils de Lyon, Lyon, France. 3. Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France. 4. Centre de Médecine Nucléaire, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France. 5. Service d'Anatomie-Pathologique, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France. 6. Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France. 7. Laboratoire Health Services and Performance Research (EA 7425 HESPER), Université Claude Bernard Lyon 1, Villeurbanne, France. 8. CarMeN Laboratory, Université Claude-Bernard Lyon 1, Inserm U1060, INRA U1397, INSA Lyon, IMBL, Villeurbanne, France.
Abstract
INTRODUCTION: Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence. METHODS: In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or >40 mm). RESULTS: A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors >40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001). CONCLUSION: The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.
INTRODUCTION: Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence. METHODS: In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or >40 mm). RESULTS: A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors >40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001). CONCLUSION: The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.
Authors: Jung Bum Choi; Seul Gi Lee; Min Jhi Kim; Tae Hyung Kim; Eun Jeong Ban; Cho Rok Lee; Jandee Lee; Sang-Wook Kang; Jong Ju Jeong; Kee-Hyun Nam; Woong Youn Chung; Cheong Soo Park Journal: Head Neck Date: 2018-12-10 Impact factor: 3.147
Authors: Denise P Momesso; Fernanda Vaisman; Samantha P Yang; Daniel A Bulzico; Rossana Corbo; Mario Vaisman; R Michael Tuttle Journal: J Clin Endocrinol Metab Date: 2016-03-29 Impact factor: 5.958
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Authors: Soon Min Choi; Dong Gyu Kim; Ji-Eun Lee; Joon Ho; Jin Kyong Kim; Cho Rok Lee; Sang-Wook Kang; Jandee Lee; Jong Ju Jeong; Woong Youn Chung; Kee-Hyun Nam Journal: Gland Surg Date: 2022-09