Management of Invasive Differentiated Thyroid Cancer

Prognostic factors for recurrence of locally advanced differentiated thyroid cancer

“…Shaving excision or wedge resection was selected in superficial invasion, which was defined as invasion depth up to the inner cartilage lamina. For intraluminal invasion of the larynx or the trachea, more radical approaches were performed (ie, partial or total laryngectomy, circumferential tracheal resection with end to end anastomosis . If the tumor involved the esophagus, shaving off the tumor, esophagus partial resection, and primary closure was adopted based on the extent of invasion.…”

“…For intraluminal invasion of the larynx or the trachea, more radical approaches were performed (ie, partial or total laryngectomy, circumferential tracheal resection with end to end anastomosis. 8,14 If the tumor involved the esophagus, shaving off the tumor, esophagus partial resection, and primary closure was adopted based on the extent of invasion. The extent of neck dissections was determined based on preoperative evaluation including physical examination, imaging and pathologic study.…”

“…To balance between the quality of life and oncologic outcome, some authors advocate conservative approaches such as shaving or gross tumor resection. These have a probability of microscopically positive margin (R1 resection), followed by adjuvant therapy (RAI or EBRT), when tumor invasion is only superficial to the perichondrium or muscle . In contrast, others have reported that R0 resection of tumors, even along with the partial or total removal of involved organs, could guarantee better local control and survival .…”

The extent of extrathyroidal extension is a key determinant of prognosis in T4a papillary thyroid cancer

“…In particular, there is increasing appreciation of the important difference in risk stratification between microscopic and macroscopic ETE (macro‐ETE) reflected in the American Thyroid Association (ATA) guidelines considering these intermediate and high risks for recurrence, respectively . Many studies have demonstrated the adverse impact of macro‐ETE involving subcutaneous soft tissue, larynx, trachea, recurrent laryngeal nerve (RLN) or esophagus . This disease pattern is incorporated into the AJCC Cancer Staging system as the primary tumor (T) classification T4a and upstages patients aged more than 55 years to stage III in the 8th edition .…”

“…4 Many studies have demonstrated the adverse impact of macro-ETE involving subcutaneous soft tissue, larynx, trachea, recurrent laryngeal nerve (RLN) or esophagus. [16][17][18][19][20][21][22] This disease pattern is incorporated into the AJCC Cancer Staging system as the primary tumor (T) classification T4a and upstages patients aged more than 55 years to stage III in the 8th edition. 23 T4a disease has been reported in 5% to 15% of patients with PTC 2, [24][25][26] and is associated with a significantly lower long-term survival compared to earlier stage diseases.…”