Oncologic outcomes in patients with 1‐cm to 4‐cm differentiated thyroid carcinoma according to extent of thyroidectomy

Abstract

Background: Recent guidelines advocate unilateral thyroidectomy for low-risk 1-cm to 4-cm differentiated thyroid cancer (DTC). This study was designed to examine the association between the extent of thyroidectomy and oncologic outcomes in patients with 1-cm to 4-cm DTC. Materials and Methods: From April 1978 to December 2011, 16 057 patients with DTC underwent thyroidectomy at Yonsei University Hospital. Among them, 5266 (32.8%) patients were classified as having 1-cm to 4-cm DTC and were enrolled in this study. Clinicopathologic features and prognostic results (diseasefree survival [DFS] and disease-specific survival [DSS] rates) were analyzed by retrospective medical record review. The mean follow-up duration was 57.3 ± 58.1 months. Results: Of tumor subtypes in the study group, papillary thyroid carcinoma was the most common (97.5%) and follicular thyroid carcinoma occurred at a rate of 2.5%. In this study, the mean tumor size was 1.84 ± 0.74 cm. Patients had extrathyroidal extension (69.3%), multiplicity (35.1%), bilaterality (26.4%), central lymph node metastasis (53.0%), and lateral neck node metastases (19.9%). Of the 5266 patients, 4292 (81.5%) underwent total thyroidectomy and 974 (18.5%) had lobectomies. Recurrence rates in the total thyroidectomy and lobectomy groups were 5.7% and 9.4%, respectively. The lobectomy group had lower DFS (P = .007) and higher DSS (P = .034) than the total thyroidectomy group. A multivariate analysis for DFS revealed that tumor size, N classification, and extent of thyroidectomy were independent risk factors. On multivariate analysis, independent risk factors for DSS were age, sex, tumor size, and M classifications. Conclusion: Although extent of thyroidectomy does not affect DSS, total thyroidectomy is beneficial for reducing recurrence in patients with 1-cm to 4-cm DTC. However, if such tumors have such low-risk features as being unifocal, intrathyroidal, and lymph node metastasis-negative, extent of thyroidectomy does not affect oncologic outcome and lobectomy may be sufficient. K E Y W O R D Sdifferentiated thyroid carcinoma, oncologic outcome, prognosis, thyroid cancer, thyroidectomy extent

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis

“…1). Table 1 summarizes the outcomes of the 14 studies that were ultimately included in the analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Two studies investigated the impact of prophylactic central neck dissection in hemithyroidectomy using a comparative method [11,19].…”

“…Two studies investigated the impact of prophylactic central neck dissection in hemithyroidectomy using a comparative method [11,19]. Six investigations compared oncological results between total thyroidectomy and hemithyroidectomy in various subjects; however, only the data regarding hemithyroidectomy were included in the present study [10,12,13,20,21,23]. Others compared recurrence according to various factors among patients who underwent hemithyroidectomy [14][15][16][17][18]22].…”

Hemithyroidectomyversustotal thyroidectomy for well differentiated T1–2 N0 thyroid cancer: systematic review and meta-analysis

“…The initial search resulted in a total of 7203 records. After removal of 2080 duplicates and screening of all titles and abstracts, a total of 68 papers were assessed in full text for inclusion, after which 58 were excluded, resulting in a total of ten studies [18][19][20][21][22][23][24][25][26][27] for analysis ( Fig. 1).…”

“…2). Median time to recurrence was reported in four studies 19,[23][24][25] and ranged from 3⋅58 to 5⋅62 years. The majority of studies defined recurrence as proven by cytology and/or pathology ( Table S4, supporting information).…”

The Impact of the Extent of Surgery on the Long-Term Outcomes of Patients with Low-Risk Differentiated Non-Medullary Thyroid Cancer: A Systematic Meta-Analysis

“…Mendelsohn et al showed that after controlling for tumor size, multivariate analysis revealed no survival difference between TT versus TL [ 41 ]. Other studies, not meeting the selection criteria for this meta-analysis, also report excellent long-term clinical outcomes in selected low-risk patients [ 46 , 48 , 49 , 50 , 51 , 52 ]. Our meta-analysis supports the lack of a significant effect of the extent of surgery on the survival outcome in the low-risk patient category amenable for TL according to the ATA guidelines.…”