Minimal extrathyroidal extension is associated with lymph node metastasis in single papillary thyroid microcarcinoma: a retrospective analysis of 814 patients.
Extrathyroidal extension
LN metastasis
Papillary thyroid Microcarcinoma
Journal
World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544
Informations de publication
Date de publication:
28 May 2022
28 May 2022
Historique:
received:
26
09
2021
accepted:
09
05
2022
entrez:
1
6
2022
pubmed:
2
6
2022
medline:
7
6
2022
Statut:
epublish
Résumé
Extrathyroidal extension (ETE) is considered a major prognostic factor in papillary thyroid carcinoma (PTC). Patients with gross ETE are at increased risk of recurrence and mortality. The importance of minimal ETE still remains controversial, especially in patients with papillary thyroid microcarcinoma (PTMC). The purpose of this study was to evaluate the association between ETE and lymph node (LN) metastasis in single PTMC. A retrospective analysis was performed of 1994 patients underwent thyroidectomy for PTC between 2012 and 2016 in a single institution. Patients with combined thyroid carcinoma of other types and those who underwent completion thyroidectomy were excluded. After further exclusion of PTC larger than 1 cm and multifocal tumors, 814 patients with single PTMC were included in the study. 72.9% patients had no ETE, 25.1% minimal ETE, and 2.1% gross ETE. ETE was associated with lymphatic invasion, perineural invasion, and vascular invasion. Patients with minimal and gross ETE were also more likely to have LN metastasis, including lateral neck metastasis, compared to those without ETE. In univariate analysis, LN metastasis was associated with male gender, conventional PTC, lymphatic invasion, perineural invasion, and ETE. In multivariate analysis, male gender (OR = 1.987; 95% CI 1.369-2.884), lymphatic invasion (OR = 4.389; 95% CI 1.522-12.658), perineural invasion (OR = 6.545; 95% CI 1.262-33.948), and minimal ETE (OR = 1.852; 95% CI 1.298-2.643) were found to be independent risk factors of LN metastasis. Minimal ETE is associated with LN metastasis in single PTMC, compared to no ETE. Minimal ETE should be considered in the management of patients with single PTMC, whether surgical or during active surveillance.
Sections du résumé
BACKGROUND
BACKGROUND
Extrathyroidal extension (ETE) is considered a major prognostic factor in papillary thyroid carcinoma (PTC). Patients with gross ETE are at increased risk of recurrence and mortality. The importance of minimal ETE still remains controversial, especially in patients with papillary thyroid microcarcinoma (PTMC). The purpose of this study was to evaluate the association between ETE and lymph node (LN) metastasis in single PTMC.
METHODS
METHODS
A retrospective analysis was performed of 1994 patients underwent thyroidectomy for PTC between 2012 and 2016 in a single institution. Patients with combined thyroid carcinoma of other types and those who underwent completion thyroidectomy were excluded. After further exclusion of PTC larger than 1 cm and multifocal tumors, 814 patients with single PTMC were included in the study.
RESULTS
RESULTS
72.9% patients had no ETE, 25.1% minimal ETE, and 2.1% gross ETE. ETE was associated with lymphatic invasion, perineural invasion, and vascular invasion. Patients with minimal and gross ETE were also more likely to have LN metastasis, including lateral neck metastasis, compared to those without ETE. In univariate analysis, LN metastasis was associated with male gender, conventional PTC, lymphatic invasion, perineural invasion, and ETE. In multivariate analysis, male gender (OR = 1.987; 95% CI 1.369-2.884), lymphatic invasion (OR = 4.389; 95% CI 1.522-12.658), perineural invasion (OR = 6.545; 95% CI 1.262-33.948), and minimal ETE (OR = 1.852; 95% CI 1.298-2.643) were found to be independent risk factors of LN metastasis.
CONCLUSIONS
CONCLUSIONS
Minimal ETE is associated with LN metastasis in single PTMC, compared to no ETE. Minimal ETE should be considered in the management of patients with single PTMC, whether surgical or during active surveillance.
Identifiants
pubmed: 35643530
doi: 10.1186/s12957-022-02629-8
pii: 10.1186/s12957-022-02629-8
pmc: PMC9148524
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
170Informations de copyright
© 2022. The Author(s).
Références
Endocrinol Metab (Seoul). 2017 Dec;32(4):434-441
pubmed: 29199400
Thyroid. 2017 May;27(5):626-631
pubmed: 27597378
Thyroid. 2014 Jun;24(6):951-7
pubmed: 24443878
World J Surg Oncol. 2020 Jul 28;18(1):188
pubmed: 32723382
World J Surg. 2006 May;30(5):780-6
pubmed: 16411013
Oral Oncol. 2017 Sep;72:183-187
pubmed: 28222967
Thyroid. 2016 Jun;26(6):807-15
pubmed: 27117842
J Endocrinol Invest. 2014 Feb;37(2):167-73
pubmed: 24497215
J Surg Oncol. 2015 Nov;112(6):592-6
pubmed: 26421594
Am J Surg. 2013 Oct;206(4):586-93
pubmed: 23790258
World J Surg Oncol. 2022 Apr 1;20(1):106
pubmed: 35365171
J Surg Oncol. 2008 Mar 1;97(3):221-5
pubmed: 18050283
Medicine (Baltimore). 2016 Dec;95(52):e5794
pubmed: 28033304
Surgery. 2008 Dec;144(6):980-7; discussion 987-8
pubmed: 19041007
World J Surg Oncol. 2021 Jul 12;19(1):208
pubmed: 34253203
World J Surg Oncol. 2021 Apr 30;19(1):138
pubmed: 33941214
Ann Surg Oncol. 2008 May;15(5):1518-22
pubmed: 18324441
J Clin Endocrinol Metab. 2018 Mar 01;:
pubmed: 29506045
J Surg Oncol. 2015 Aug;112(2):149-54
pubmed: 26175314
Am J Surg. 1995 Nov;170(5):467-70
pubmed: 7485734
World J Surg Oncol. 2018 Oct 12;16(1):205
pubmed: 30314503
Surgery. 2016 Jan;159(1):11-9
pubmed: 26514317
J Thyroid Res. 2020 Mar 24;2020:3567658
pubmed: 32351678
Surgery. 1987 Dec;102(6):1088-95
pubmed: 3686348
World J Surg Oncol. 2021 Jul 13;19(1):211
pubmed: 34256769
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
Ann Surg Oncol. 2011 Jul;18(7):1916-23
pubmed: 21267788
Thyroid. 2014 Feb;24(2):241-4
pubmed: 23713855
J Nucl Med. 2021 Mar 26;:
pubmed: 33771902
Oral Oncol. 2015 Aug;51(8):759-63
pubmed: 26093388