Journal Article

Long-Term Recurrence of Small Papillary Thyroid Cancer and Its Risk Factors in a Korean Multicenter Study

Lee, You Jin, Koong, Sung-Soo, Park, Young Joo, Kim, Sun Wook, Lee, Eun Kyung, Hwangbo, Yul, Kim, Min Hee, Kim, Min Joo, Jung, Jung Hwa, Lim, Dong Jun, Jo, Young Suk, Kim, Jung Min, Chung, Jae Hoon, Hahm, Jong Ryeal, Yi, Ka Hee, Sohn, Seo Young, Park, Do Joon, Choi, Young Sik, Shong, Min Ho, Lee, Kang Dae

2017

Overview

Context:Small papillary thyroid cancer (PTC) generally has an excellent prognosis. However, long-term recurrence is not uncommon and sometimes leads to morbidity or mortality.Objective:To identify high-risk factors for long-term recurrence in patients with small PTC by stratifying their pathologic characteristics.Design, Setting, and Patients:We conducted a nationwide, retrospective, multicenter study of 3282 patients with PTC sized ≤2 cm from 9 high-volume hospitals in Korea.Main Outcome Measures:The maximally selected χ2 method was used to find the best cutoff points of tumor size, the number of metastatic lymph nodes (LNs), and the ratio of metastatic/examined LNs (LNR) to predict recurrence. Kaplan-Meier analysis and the Cox proportional hazards regression model were used to analyze recurrence and risk factors.Results:The optimal tumor size cutoff was 1.8 cm (10-year recurrence rates for tumors sized 0.1 to 1.7 cm and 1.8 to 2.0 cm: 7.7% vs 17.2%, respectively). Metastatic LNs ≤1 and ≥2 provided optimal estimates of recurrence (10-year recurrence rates: 4.0% vs 16.8%, respectively). The LNR of 0.19 was the optimal cutoff point for predicting the risk of recurrence (10-year recurrence rates for LNRs of 0 to 0.18 and 0.19 to 1: 2.7% vs 16.2%, respectively). LN metastasis, lobectomy, tumor size ≥1.8 cm, and bilateral tumors were independent risk factors for recurrence.Conclusions:Long-term recurrence was increased in patients who underwent lobectomy or with tumor sized ≥1.8 cm, 2 or more metastatic LNs, or bilateral tumors. For patients with these high-risk features, total thyroidectomy could be considered to avoid reoperation.Lobectomy, tumor size ≥1.8 cm, 2 or more metastatic lymph nodes, and bilateral tumors were independent risk factors for recurrence in patients with papillary thyroid cancer sized ≤2.0 cm.

• Publisher: Endocrine Society,Copyright Oxford University Press,Oxford University Press
• Subject: Adult / Carcinoma - diagnosis / Carcinoma - epidemiology / Carcinoma - pathology / Carcinoma - surgery / Carcinoma, Papillary / Female / Follow-Up Studies / Health risk assessment / Humans / Lymph nodes / Lymphatic system / Male / Metastases / Metastasis / Middle Aged / Morbidity / Neoplasm Recurrence, Local - diagnosis / Neoplasm Recurrence, Local - epidemiology / Neoplasm Recurrence, Local - pathology / Papillary thyroid cancer / Prognosis / Republic of Korea - epidemiology / Retrospective Studies / Risk Assessment - methods / Risk Assessment - statistics & numerical data / Risk Factors / Thoracic surgery / Thyroid cancer / Thyroid Cancer, Papillary / Thyroid Neoplasms - diagnosis / Thyroid Neoplasms - epidemiology / Thyroid Neoplasms - pathology / Thyroid Neoplasms - surgery / Thyroidectomy / Thyroidectomy - methods / Thyroidectomy - statistics & numerical data / Tumors