Prognostic Significance of Extrathyroid Extension of Papillary Thyroid Carcinoma: Massive but Not Minimal Extension Affects the Relapse‐free Survival

Ito, Yasuhiro; Tomoda, Chisato; Uruno, Takashi; Takamura, Yuuki; Miya, Akihiro; Kobayashi, Kaoru; Matsuzuka, Fumio; Kuma, Kanji; Miyauchi, Akira

doi:10.1007/s00268-005-0270-z

Cited by 248 publications

(215 citation statements)

References 14 publications

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“…The presence of macroscopic, but not microscopic, lymph-node involvement is the strongest risk factor for LNR while a bilateral dissection of central and lateral compartments is associated with lower risk at multivariate analysis. As previously reported, extra-thyroidal invasion (1,5,6,(14)(15)(16) and male gender (1,5,6,15,17) are also related to an increased risk. The present data clearly show that the effects of LND differ in patients with and without macroscopic lymphnode metastases.…”

Section: Discussionsupporting

confidence: 63%

Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

Bardet

Malville

Rame

et al. 2008

European Journal of Endocrinology

169

124

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Objective: Whether lymph-node dissection (LND) influences the lymph-node recurrence (LNR) risk in patients with papillary thyroid cancer remains controversial. The prognostic impact of macroscopic and microscopic lymph-node involvement at diagnosis is also an unresolved issue. A retrospective study was conducted to assess the influence of various LND procedures and to search for LNR risk factors. Methods: Overall 545 patients without distant metastases prior to surgery and main tumour R10 mm were included. A total thyroidectomy was performed in all patients with either no LND (Group 1, nZ161), bilateral LND of the central and lateral compartments (Group 2, nZ181) or all other dissection modalities (Group 3, nZ203). Post-operative radioiodine was given to 496 (91%) patients. The 10-year cumulative probability of LNR was assessed and a prognostic study using multivariate analysis was performed. Results: Macroscopic lymph-node metastases were present in 118 patients, 57 diagnosed before surgery and 61 only at surgery (including 81% in the central compartment). Overall, the 10-year cumulative probability of LNR was 7%. Macroscopic lymph-node metastases (PZ0.001), extra-thyroidal invasion (PZ0.017) and male gender (PZ0.05) were independent risk factors, while bilateral LND of the central and lateral compartments was protective (PZ0.028). In patients with macroscopic lymph-node metastases, the 10-year probability was lower in Group 2 than in Group 3 (10% vs 30%, P!0.01). In patients without macroscopic lymph-node metastases (nZ427), no significant differences were observed between the three LND groups. Conclusions: Patients with macroscopic, but not microscopic, lymph-node involvement have a major LNR risk and need an optimal LND at primary surgery.

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Section: Discussionsupporting

confidence: 63%

Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

Bardet

Malville

Rame

et al. 2008

European Journal of Endocrinology

169

124

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“…Male gender, multicentricity, and advanced age are known to be conventional prognostic factors of papillary carcinoma [3,4], but these features did not affect PMC progression during observation. Furthermore, we failed to establish a relationship between carcinoma enlargement and tumor size at diagnosis.…”

Section: Discussionmentioning

confidence: 83%

“…Usually, papillary carcinoma is indolent and grows slowly, although cases having certain biological characteristics, such as clinically apparent node metastasis in the lateral compartment (N1b in the International Union Against Cancer [UICC] tumor node metastasis [TNM] classification [1]) and massive extrathyroid extension (pT4 [1]) are progressive [2][3][4]. Papillary carcinoma measuring 1.0 cm or less is defined as papillary microcarcinoma (PMC) by the World Health Organisation (WHO) classification.…”

Section: Introductionmentioning

confidence: 99%

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

et al. 2009

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Background The recent development and spread of ultrasonography and ultrasonography-guided fine needle aspiration biopsy (FNAB) has facilitated the detection of small papillary microcarcinomas of the thyroid measuring 1 cm or less (PMC). The marked difference in prevalence between clinical thyroid carcinoma and PMC detected on mass screening prompted us to observe PMC unless the lesion shows unfavorable features, such as location adjacent to the trachea or on the dorsal surface of the thyroid possibly invading the recurrent laryngeal nerve, clinically apparent nodal metastasis, or high-grade malignancy on FNAB findings. In the present study we report comparison of the outcomes of 340 patients with PMC who underwent observation and the prognosis of 1,055 patients who underwent immediate surgery without observation. Methods Between 1993 and 2004, 340 patients underwent observation and 1,055 underwent surgical treatment without observation. These 1,395 patients were enrolled in the present study. Observation periods ranged from 18 to 187 months (average 74 months). Results The proportions of patients whose PMC showed enlargement by 3 mm or more were 6.4 and 15.9% on 5-year and 10-year follow-up, respectively. Novel nodal metastasis was detected in 1.4% at 5 years and 3.4% at 10 years. There were no factors related to patient background or clinical features linked to either tumor enlargement or the novel appearance of nodal metastasis. After observation 109 of the 340 patients underwent surgical treatment for various reasons, and none of those patients showed carcinoma recurrence. In patients who underwent immediate surgical treatment, clinically apparent lateral node metastasis (N1b) and male gender were recognized as independent prognostic factors of disease-free survival. Conclusions Papillary microcarcinomas that are not associated with unfavorable features can be candidates for observation regardless of patient background and clinical features. If there are subsequent signs of progression, such as tumor enlargement and novel nodal metastasis, it would not be too late to perform surgical treatment. Even though the primary tumor is small, careful surgical treatment including therapeutic modified neck dissection is necessary for N1b PMC patients.

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“…By contrast, the prevalence of clinical thyroid papillary carcinoma was 1.9-11.7 per 100,000 people of all ages (22), suggesting that the subclinical thyroid carcinoma is almost one thousand times lower than the apparent clinical type. A previous study (23) even suggested that patients without high-risk factors of thyroid carcinoma should not immediately undergo surgery.…”

Section: Discussionmentioning

confidence: 87%

Outcome of papillary thyroid microcarcinoma: Study of 1,990 cases

Zhang

Wei

et al. 2015

Molecular and Clinical Oncology

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Abstract. The present study examines the requirement of prophylactic neck node dissection in papillary thyroid microcarcinoma (PTMC) patients by analyzing high-risk factors of neck lymph node metastasis in PTMC. The clinical pathological data was a review of 1,990 patients diagnosed between January 2013 and January 2014. The data included information on patient gender, age, tumor size, multifocal, tumor pathological staging, bilateral thyroid cancer, the subtypes, BRAF V600E mutation, human telomerase reverse transcriptase (hTERT), extrathyroidal invasion and neck lymph node metastasis. The univariate analysis (χ 2 test) showed that a number of factors were significantly associated with neck lymph node metastasis in PTMC (P<0.05): Male gender, aged <45 years, extrathyroidal invasion, bilateral thyroid cancer, various subtypes (package type, follicular variant, diffuse sclerosing variant, eosinophils, tall cell and column variant), BRAF V600E mutation-positive, hTERT mutation-positive, pt3/4 and multifocality. The multivariate analysis (regression binary logistic) showed that the male gender, <45 years, tumor size >5 mm, extrathyroidal invasion, bilateral thyroid tumors, multifocality, BRAF V600E mutation-positive, hTERT mutation-positive and pt3/4 are associated with the neck lymph node metastasis in PTMC (P<0.05). These paired analysis results show that the subtypes of PTMC with tumor size >5 mm is more common than the specific types of PTMC in which the tumor is ≤5 mm in neck lymph node metastasis. The neck lymph node metastasis incidence of the >45 years age group patients without high-risk factors in PTMC is 8.13 and 6.80%, respectively. In conclusion, PTMC patients with high-risk factors only are recommended to undergo a prophylactic lymph node dissection.

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Prognostic Significance of Extrathyroid Extension of Papillary Thyroid Carcinoma: Massive but Not Minimal Extension Affects the Relapse‐free Survival

Cited by 248 publications

References 14 publications

Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma.

An Observational Trial for Papillary Thyroid Microcarcinoma in Japanese Patients

Outcome of papillary thyroid microcarcinoma: Study of 1,990 cases

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