Predictive factors for recurrence of papillary thyroid carcinoma: analysis of 4,085 patients

Abstract

Objective. The incidence of papillary thyroid carcinoma (PTC) has increased in recent years and its treatment remains controversial. The objective of this study is to identify clinicopathological predictive factors of tumour recurrence. Methods. We retrospectively analysed 4,085 patients who underwent thyroidectomy for PTC from 1996 to 2015. Patients were stratified according to American Thyroid Association (ATA) risk categories and clinicopathological features were evaluated to identify independent factors for recurrence. Results. After a mean follow-up of 58.7 (range 3-256.5) months, tumour recurrence was diagnosed in 176 (4.3%) patients, mostly in lymph nodes. Distant metastasis occurred in 18 patients (0.4%). There were 3 (0.1%) cancer-related deaths. Multivariate analysis showed that tumour size >10 mm, multifocality, extrathyroidal extension and lymph node metastasis (all, P < 0.001) were independent risk factors for recurrence. Further, recurrence was identified in 1.6% of the ATA low-risk, 7.4% of the intermediate-risk and 22.7% of the high-risk patients (P < 0.001). Conclusions. In PTC patients, tumour size >10 mm, multifocality, extrathyroidal extension and presence of lymph node metastasis as well as the ATA recurrence staging system effectively predict recurrence.

Is multifocality a risk factor in low-risk papillary thyroid cancer?

“…Also, Chow et al [4] found that the risk of cervical lymph node recurrence increased 6.2-fold and 5.6-fold when LN metastases and multifocal disease were present at diagnosis, respectively. These data are consistent with the findings of many other authors [13,18,[28][29][30][31][32].…”

“…At the last control visit, persistent/recurrent disease was defined by one or more of the following criteria: (1) serum Tg, either under suppressive L-T4 therapy or after TSH stimulation, at detectable levels and/or higher than the value defined on the basis of the assay sensitivity at the time of measurement; (2) metastatic LN identified at ultrasound and confirmed by fine needle aspiration (FNAB) with Tg measurement in the aspirate washout; and (3) positive 131 I-WBS. All patients presenting persistent/recurrent disease during follow-up underwent additional diagnostic imaging procedures and surgery and/or RAI treatment and/or other therapies as required [31,32].…”

Predictive factors affecting the development of central lymph node metastasis in papillary thyroid cancer

“…[ 31 ] In two recent studies in the literature, it has been shown that the development of CLNM in PTC patients under the age of 45 is higher than in patients over the age of 45. [ 32 , 33 ] In our study, the mean age in the group with CLNM was found to be significantly lower than the group without nodal metastasis (41.77+16.79 vs. 48.18+13.24; p=0.008). However, in our study, as in the latest version of the TNM staging system (Edition 8), when we stratified patients according to 55 years of age, no significant difference was found in terms of CLNM development between in patients younger and older than 55.…”

Sonographic Diagnosis of Cervical Lymph Node Metastasis in Patients with Thyroid Cancer and Comparison of European and Korean Guidelines for Stratifying the Risk of Malignant Lymph Node

“…The accurate preoperative diagnosis of LN metastasis is important for patients with DTCs to determine the optimal surgical extent and reduce persistent or recurrent disease and reoperation complications [ 6 ]. Moreover, LN metastasis is an important prognostic factor; particularly, lateral LN metastasis increases the risk of locoregional recurrence and decreases the rate of disease-free survival among patients with papillary thyroid carcinoma [ 1 4 7 8 ].…”