Long-Term Outcomes After Lobectomy for Patients with High-Risk Papillary Thyroid Carcinoma.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
accepted:
28
07
2022
pubmed:
17
8
2022
medline:
4
1
2023
entrez:
16
8
2022
Statut:
ppublish
Résumé
Guidelines universally recommend total thyroidectomy for high-risk papillary thyroid carcinoma (PTC). However, in Japan, thyroid-conserving surgery had been widely applied for such patients until recently. We investigated long-term outcomes for this strategy. A prospectively recorded database was retrospectively analyzed for 368 patients who had undergone curative surgery for high-risk PTC without distant metastasis between 1993 and 2013. High-risk PTC was defined for tumors showing tumor size > 4 cm, extrathyroidal extension, or large nodal metastasis ≥ 3 cm. Median age was 59 years and 243 patients were female. Mean duration of follow-up was 12.7 years. Lobectomy was conducted for 207 patients (LT group) and total or near-total thyroidectomy for 161 patients (TT group). The frequency of massive extrathyroidal invasion and large nodal metastasis was lower in the LT group than in the TT group. After propensity score matching, no significant differences were seen between groups for overall survival, cause-specific survival or distant recurrence-free survival. In the overall cohort, multivariate analysis identified age ≥ 55 years, large nodal metastasis, tumor size > 4 cm and massive extrathyroidal invasion as significantly associated with cause-specific survival, whereas extent of thyroidectomy was not. For patients with high-risk PTC without distant metastasis, curative surgery with lobectomy showed almost identical oncological outcomes compared to total thyroidectomy. The benefits of total thyroidectomy for high-risk PTC should be reevaluated in the future prospective studies.
Sections du résumé
BACKGROUND
Guidelines universally recommend total thyroidectomy for high-risk papillary thyroid carcinoma (PTC). However, in Japan, thyroid-conserving surgery had been widely applied for such patients until recently. We investigated long-term outcomes for this strategy.
METHODS
A prospectively recorded database was retrospectively analyzed for 368 patients who had undergone curative surgery for high-risk PTC without distant metastasis between 1993 and 2013. High-risk PTC was defined for tumors showing tumor size > 4 cm, extrathyroidal extension, or large nodal metastasis ≥ 3 cm.
RESULTS
Median age was 59 years and 243 patients were female. Mean duration of follow-up was 12.7 years. Lobectomy was conducted for 207 patients (LT group) and total or near-total thyroidectomy for 161 patients (TT group). The frequency of massive extrathyroidal invasion and large nodal metastasis was lower in the LT group than in the TT group. After propensity score matching, no significant differences were seen between groups for overall survival, cause-specific survival or distant recurrence-free survival. In the overall cohort, multivariate analysis identified age ≥ 55 years, large nodal metastasis, tumor size > 4 cm and massive extrathyroidal invasion as significantly associated with cause-specific survival, whereas extent of thyroidectomy was not.
CONCLUSIONS
For patients with high-risk PTC without distant metastasis, curative surgery with lobectomy showed almost identical oncological outcomes compared to total thyroidectomy. The benefits of total thyroidectomy for high-risk PTC should be reevaluated in the future prospective studies.
Identifiants
pubmed: 35972533
doi: 10.1007/s00268-022-06705-8
pii: 10.1007/s00268-022-06705-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
382-391Informations de copyright
© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Sugitani I, Fujimoto Y (2010) Management of low-risk papillary thyroid carcinoma: unique conventional policy in Japan and our efforts to improve the level of evidence. Surg Today 40:199–215
doi: 10.1007/s00595-009-4034-5
Tuttle RM, Haugen B, Perrier ND (2017) Updated American joint committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 27:751–756
doi: 10.1089/thy.2017.0102
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133
doi: 10.1089/thy.2015.0020
Sugitani I, Kasai N, Fujimoto Y et al (2004) A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135:139–148
doi: 10.1016/S0039-6060(03)00384-2
Ebina A, Sugitani I, Fujimoto T et al (2014) Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: is thyroid lobectomy the treatment of choice for low-risk patients? Surgery 156:1579–1589
doi: 10.1016/j.surg.2014.08.060
Matsuura D, Yuan A, Harris V et al (2022) Surgical management of low-/intermediate-risk node negative thyroid cancer: a single-institution study using propensity matching analysis to compare thyroid lobectomy and total thyroidectomy. Thyroid 32:28–36
doi: 10.1089/thy.2021.0356
Matsuzu K, Sugino K, Masudo K et al (2014) Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J Surg 38:68–79. https://doi.org/10.1007/s00268-013-2224-1
doi: 10.1007/s00268-013-2224-1
Song E, Han M, Oh HS et al (2019) Lobectomy is feasible for 1–4 cm papillary thyroid carcinomas: a 10-year propensity score matched-pair analysis on recurrence. Thyroid 29:64–70
doi: 10.1089/thy.2018.0554
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: thyroid carcinoma. Version1.2022-Apr 5, 2022 https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf
Ito Y, Onoda N, Okamoto T (2020) The revised clinical practice guidelines on the management of thyroid tumors by the Japan associations of endocrine surgeons: core questions and recommendations for treatments of thyroid cancer. Endocr J 67:669–717
doi: 10.1507/endocrj.EJ20-0025
Filetti S, Durante C, Hartl D et al (2019) Thyroid cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 30:1856–1883
doi: 10.1093/annonc/mdz400
Wanebo H, Coburn M, Teates D et al (1998) Total thyroidectomy does not enhance disease control or survival even in high-risk patients with differentiated thyroid cancer. Ann Surg 227:912–921
doi: 10.1097/00000658-199806000-00015
Xu S, Huang H, Wang X et al (2021) Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features. BJS 108:395–402
doi: 10.1093/bjs/znaa129
Ebina A, Togashi Y, Baba S et al (2020) TERT promoter mutation and extent of thyroidectomy in patients with 1–4 cm intrathyroidal papillary carcinoma. Cancers 12:2115. https://doi.org/10.3390/cancers12082115
doi: 10.3390/cancers12082115
Hotomi M, Sugitani I, Toda K et al (2012) A novel definition of extrathyroidal invasion for patients with papillary thyroid carcinoma for predicting prognosis. World J Surg 36:1231–1240. https://doi.org/10.1007/s00268-012-1518-z
doi: 10.1007/s00268-012-1518-z
Sugitani I, Fujimoto Y, Yamada K et al (2008) Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg 32:2494–2502. https://doi.org/10.1007/s00268-008-9711-9
doi: 10.1007/s00268-008-9711-9
Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transpl 48:452–458
doi: 10.1038/bmt.2012.244
Welch HG, Doherty GM (2018) Saving thyroids: overtreatment of small papillary cancers. N Engl J Med 379:310–312
doi: 10.1056/NEJMp1804426
Hauch A, Al-Qurayshi Z, Randolph G et al (2014) Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol 21:3844–3852
doi: 10.1245/s10434-014-3846-8
Landa I, Ganly I, Chan TA et al (2013) Frequent somatic TERT promoter mutations in thyroid cancer: higher prevalence in advanced forms of the disease. J Clin Endocrinol Metab 98:E1562-1566
doi: 10.1210/jc.2013-2383
Bullock M, Ren Y, O’Neill C et al (2016) TERT promoter mutations are a major indicator of recurrence and death due to papillary thyroid carcinomas. Clin Endocrinol 85:283–290
doi: 10.1111/cen.12999
Goswami S, Peipert BJ, Mongelli MN et al (2019) Clinical factors associated with worse quality-of-life scores in USA thyroid cancer survivors. Surgery 166:69–74
doi: 10.1016/j.surg.2019.01.034
Bongers PJ, Greenberg CA, Hsiao R et al (2020) Differences in long-term quality of life between hemithyroidectomy and total thyroidectomy in patients treated for low-risk differentiated thyroid carcinoma. Surgery 167:94–101
doi: 10.1016/j.surg.2019.04.060
Nickel B, Tan T, Cvejic E et al (2019) Health-related quality of life after diagnosis and treatment of differentiated thyroid cancer and association with type of surgical treatment. JAMA Otolaryngol Head Neck Surg 145:231–238
doi: 10.1001/jamaoto.2018.3870
Chen W, Li J, Peng S et al (2022) Association of total thyroidectomy or thyroid lobectomy with the quality of life in patients with differentiated thyroid cancer with low to intermediate risk of recurrence. JAMA Surg 157:200–209
doi: 10.1001/jamasurg.2021.6442
Tuttle RM, Tala H, Shah J et al (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American thyroid association staging system. Thyroid 20:1341–1349
doi: 10.1089/thy.2010.0178
Momenso DP, Vaisman F, Yang SP et al (2016) Dynamic risk stratification in patients with differentiated thyroid cancer treated without radioactive iodine. J Clin Endocrinol Metab 101:2692–2700
doi: 10.1210/jc.2015-4290
Park JH, Yoon JH (2019) Lobectomy in patients with differentiated thyroid cancer: indications and follow-up. Endocr Relat Cancer 26:R381-393
doi: 10.1530/ERC-19-0085
Cho JW, Lee Y, Lee YH et al (2018) Dynamic risk stratification system in post-lobectomy low-risk and intermediate-risk papillary thyroid carcinoma patients. Clin Endocrinol 89:100–109
doi: 10.1111/cen.13721
Park S, Kim WG, Song E et al (2017) Dynamic risk stratification for predicting recurrence in patients with differentiated thyroid cancer treated without radioactive iodine remnant ablation therapy. Thyroid 27:524–530
doi: 10.1089/thy.2016.0477
Miyauchi A, Kudo T, Miya A et al (2011) Prognostic impact of serum thyroglobulin doubling-time under thyrotropin suppression in patients with papillary thyroid carcinoma who underwent total thyroidectomy. Thyroid 21:707–716
doi: 10.1089/thy.2010.0355
Brose MS, Nutting CM, Jarzab B et al (2014) Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 384:319–328
doi: 10.1016/S0140-6736(14)60421-9
Schlumberger M, Tahara M, Wirth LJ et al (2015) Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. New Engl J Med 372:621–630
doi: 10.1056/NEJMoa1406470
Fullmer T, Cabanillas ME, Zafereo M (2021) Novel therapeutics in radioactive iodine-resistant thyroid cancer. Front Endocrinol 12:720723. https://doi.org/10.3389/fendo.2021.720723
doi: 10.3389/fendo.2021.720723