Long-term outcome of thyroid lobectomy for unilateral multifocal papillary carcinoma

Huang, Hui; Liu, Shaoyan; Xu, Zhengang; Song, Ning; Zhang, Zongmin; Wang, Xiaolei

doi:10.1097/md.0000000000007461

Cited by 23 publications

(23 citation statements)

References 13 publications

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“…Many studies had noted that pathological factors that necessitate completion thyroidectomy includes multifocality, extrathyroidal extension, and some studies also quote the size of the nodule [12,13]. In our study, it was noted that patients with age more than 55 years 6.67 times increased risk of malignancy compared to middle age group (25-54 years).…”

Section: Discussionsupporting

confidence: 52%

Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

Riju

Thomas

Anila

2018

Indian J Surg Oncol

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Completion thyroidectomy, being a surgically challenging procedure, choice of doing such procedure in differentiated thyroid cancer (DTC), remains unclear due to the complications involved following the procedure. So this study is intended to look into risk factors that will prompt completion thyroidectomy and surgery-related complications. A prospective analysis was done in 48 patients diagnosed with DTC during the year 2017. Completion thyroidectomy with or without neck dissection was performed as per institutional protocol. Clinico-radiological features were compared with histopathology in completion thyroidectomy specimen. The incidence of malignancy in completion thyroidectomy specimen and complications during the procedure were noted. Risk factors associated with malignancy were statistically analyzed. The incidence of malignancy in completion thyroidectomy specimen was 56.25%. Papillary carcinoma thyroid (PCT) had a statistically significant risk compared to follicular carcinoma thyroid (p = 0.042). Also, capsular invasion in primary specimen had a significant impact (p = 0.021) with odds of 7.20 times increase in incidence of malignancy and patients with age more than 55 years had a significantly increased risk of malignancy (p = 0.05). There was no statistically significant increase in complications following procedure, with respect to duration between surgeries or type of surgeries performed. Incidence of malignancy in completion thyroidectomy specimen was high. Completion thyroidectomy can be safely performed under experienced hands with an acceptable level of complications. It should be considered in places where patients are non-compliant and in those with PCT, tumor with capsular invasion and elderly patients.

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Section: Discussionsupporting

confidence: 52%

Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

Riju

Thomas

Anila

2018

Indian J Surg Oncol

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“…[ 7 , 9 – 12 ] The high risk of recurrence in pediatrics distinguishes pediatric DTC from its adult counterpart. One recent study examined DTC patients with a high risk of recurrence with a median age of 43 years and reported a recurrence rate at 10 years of 16.8%, [ 13 ] nearly half the value in the present study.…”

Section: Discussionmentioning

confidence: 52%

Prognostic analysis of recurrence in children and adolescents with differentiated thyroid cancer

Wang

2020

Chinese Medical Journal

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Background: The standard treatment for pediatric differentiated thyroid carcinoma (DTC) still requires consideration because of a lack of clinical evidence. The purpose of this study was to summarize the clinical experiences and explore the risk factors for post-operative recurrence through a retrospective analysis to develop better clinical strategies for pediatric DTC. Methods: This study retrospectively analyzed children and adolescents with DTC who were treated between January 1999 and December 2014 at the Cancer Hospital, Chinese Academy of Medical Sciences. Clinicopathological results and outcomes were collected. A log-rank test of Kaplan-Meier curves and the Cox regression model were used to determine the factors associated with recurrence. Results: Data of 150 patients were collected in this study. During the follow-up, there was only one disease-related death. The recurrence rates at 3, 5, and 10 years were 13.6%, 18.7%, and 28.6%, respectively. There was a significant difference in the rate of recurrence according to age ( P < 0.001), extrathyroidal extension ( P < 0.001), lymph node metastasis ( P = 0.023), and invasion of the trachea and esophageal wall ( P = 0.004). Cox regression analysis demonstrated that age ( P = 0.006) and extrathyroidal extension ( P = 0.013) were significant dependent factors of post-operative recurrence. Conclusions: The prognosis of DTC in children and adolescents is favorable. A close follow-up is recommended because of the high recurrence rate. A comparatively higher recurrence rate was observed in the younger age group, and new age-based divisions may be needed to conveniently evaluate the possibility of recurrence.

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“…This result, together with the recurrence pattern, indicates that a degree of occult contralateral PTC led to frequent recurrence in the contralateral thyroid lobe. Indeed, several studies have shown that unilateral multifocality of the primary tumour is an independent predictor of occult contralateral PTC; thus, initial total thyroidectomy or completion thyroidectomy after hemithyroidectomy is recommended in patients with multifocal disease. However, the recurrence rate among patients with multifocal PTC in the present study was only 11 per cent (6 of 57), which would not be enough for initial total thyroidectomy or completion thyroidectomy to be recommended in these patients.…”

Section: Discussionmentioning

confidence: 99%

Recurrence following hemithyroidectomy in patients with low- and intermediate-risk papillary thyroid carcinoma

Ahn

Lee

Sohn

2020

British Journal of Surgery

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Background: This study evaluated the incidence, patterns and risk factors for recurrence after hemithyroidectomy in patients with low-and intermediate-risk papillary thyroid carcinoma (PTC), and verified the predictive role of the risk staging systems in current use. Methods: The clinicopathological characteristics and risk categories were analysed according to recurrence in patients who underwent hemithyroidectomy for low-and intermediate-risk conventional PTC, and were followed up for at least 24 months. Five risk staging systems were used to stratify risk: the 2015 American Thyroid Association (ATA) system; Age, Metastases, Extent and Size (AMES) system; Metastases, Age, Complete resection, Invasion and Size (MACIS) system; Grade, Age, Metastases, Extent and Size (GAMES) system; and the eighth AJCC system. Results: The study included 561 patients; 93⋅9 per cent of the study population (527 of 561) had a papillary thyroid microcarcinoma 1 cm or smaller in size. At a mean follow-up of 83 months, 25 patients (4⋅5 per cent) had recurrence; among these patients, 23 (92%) presented with a remaining thyroid lobe. Multifocality was significantly associated with recurrence in univariable and multivariable analyses (adjusted hazard ratio 3⋅16, 95 per cent c.i. 1⋅25 to 7⋅98; P = 0⋅015). Disease-free survival (DFS) varied according to multifocality (P = 0⋅010). The five risk staging systems were not associated with recurrence, and their Harrell's C-index ranged from 0⋅500 to 0⋅531. DFS rates did not differ between the risk categories in each system. Conclusion:Although the recurrence rate after hemithyroidectomy in patients with low-and intermediate-risk PTC was low, meticulous follow-up focusing on the remaining thyroid lobe is needed for early detection and timely management of recurrence. The risk scoring systems in current use have no predictive role in these patients.

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Long-term outcome of thyroid lobectomy for unilateral multifocal papillary carcinoma

Cited by 23 publications

References 13 publications

Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

Completion Thyroidectomy in Differentiated Thyroid Malignancy—A Prospective Analysis

Prognostic analysis of recurrence in children and adolescents with differentiated thyroid cancer

Recurrence following hemithyroidectomy in patients with low- and intermediate-risk papillary thyroid carcinoma

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