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

Abstract

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.

Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis

“…However, it is necessary to investigate the clinical and prognostic implications of multifocality on PTMC, based on the consensus that PTMC has different genetic characteristics, 21 biological behaviour and corresponding clinical management compared with PTC 10,11 . In fact, some studies have focused on the role of multifocality and its bilaterality in the aggression and prognosis of PTMC 7,8,12,13,16,17 . However, some confounding factors, such as sample selection bias and poor matching of baseline characteristics, affect the reliability of the results.…”

“…The American Thyroid Association (ATA) guideline included multifocal PTMC without ETE in the low‐risk category, while ETE was included in the intermediate‐risk category 11 . However, recent studies have shown that multifocality is associated with aggressive progression of the disease (ETE and/or LNM) and impacts the prognosis 7,8,12,13 . Several studies on PTMC and papillary thyroid carcinoma (PTC) have shown that bilateral multifocality accounted for the majority of multifocal cases, 8,9,14,15 and it was an independent predictor for LNM and should be treated aggressively 16,17 .…”

“…11 However, recent studies have shown that multifocality is associated with aggressive progression of the disease (ETE and/or LNM) and impacts the prognosis. 7,8,12,13 Several studies on PTMC and papillary thyroid carcinoma (PTC) have shown that bilateral multifocality accounted for the majority of multifocal cases, 8,9,14,15 and it was an independent predictor for LNM and should be treated aggressively. 16,17 In addition, one study suggested that patients with bilateral multifocality had more aggressive features and shorter disease-free survival than patients with PTC and unilateral multifocality.…”

Tumor Mutation Burden Predicts Relapse in Papillary Thyroid Carcinoma With Changes in Genes and Immune Microenvironment

“…Although the recurrence rate of some low-risk and intermediate-risk PTC patients undergoing hemithyroidectomy is low, the current risk scoring system has no predictive effect on these patients, which needs to be followed up to detect and treat the recurrence early (3). The aggressive clinical pathological, age ≥55, male, tumor size >4 cm, tall cell variant, and positive lymph node metastasis are independent prognostic factors, and there may continue to be the risk of cancer death and early recurrence (4)(5)(6)(7).…”

Clinical Relevance and Management of Recurrent Laryngeal Nerve Inlet Zone Lymph Nodes Metastasis in Papillary Thyroid Cancer

“…In spite of low mortality, 3-7.9% of patients have loco-regional recurrence within 5 years after initial surgery (5)(6)(7)(8)(9). Of these patients, structural recurrence in the central compartment accounts for 20-55.6% of all loco-regional recurrences (4,7,(9)(10)(11). This proportion of early nodal recurrence reflects the inadequacy of initial surgical management (12,13).…”