The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study.
Disease-free survival
Microscopic extrathyroidal extension
Papillary thyroid microcarcinoma
Recurrence
Journal
Endocrine
ISSN: 1559-0100
Titre abrégé: Endocrine
Pays: United States
ID NLM: 9434444
Informations de publication
Date de publication:
22 Sep 2023
22 Sep 2023
Historique:
received:
05
07
2023
accepted:
10
09
2023
medline:
22
9
2023
pubmed:
22
9
2023
entrez:
22
9
2023
Statut:
aheadofprint
Résumé
Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC. The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox's proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method. This study included 1013 patients (84% females), with a mean follow-up period of 62.5 ± 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02-5.81, p = 0.043; HR: 4.38, 95% CI: 1.7-11.2, p = 0.002, respectively). In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.
Identifiants
pubmed: 37736822
doi: 10.1007/s12020-023-03533-1
pii: 10.1007/s12020-023-03533-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
M. Pereira, V.L. Williams, J. Hallanger Johnson, P. Valderrabano, Thyroid cancer incidence trends in the United States: Association with changes in professional guideline recommendations. Thyroid 30, 1132–1140 (2020)
doi: 10.1089/thy.2019.0415
pubmed: 32098591
C.M. Kitahara, J.A. Sosa, The changing incidence of thyroid cancer. Nat. Rev. Endocrinol. 12, 646–653 (2016)
doi: 10.1038/nrendo.2016.110
pubmed: 27418023
pmcid: 10311569
D.T. Hughes, M.R. Haymart, B.S. Miller, P.G. Gauger, G.M. Doherty, The most commonly occurring papillary thyroid cancer in the United States is now a microcarcinoma in a patient older than 45 years. Thyroid 21, 231–236 (2011)
doi: 10.1089/thy.2010.0137
pubmed: 21268762
A. Miyauchi, Clinical trials of active surveillance of papillary microcarcinoma of the thyroid. World J. Surg. 40, 516–522 (2016)
doi: 10.1007/s00268-015-3392-y
pubmed: 26744340
pmcid: 4746213
M. Van Gerwen, N. Alpert, C. Sinclair, M. Kale, E. Genden, E. Taioli, Assessing non-aggressiveness of untreated, local and regional, papillary thyroid cancer. Oral. Oncol. 105, 104674 (2020)
doi: 10.1016/j.oraloncology.2020.104674
pubmed: 32279012
S.S. Zuhur, H. Aggul, U. Avci et al. Do histologically aggressive subtypes of papillary thyroid microcarcinoma have worse clinical outcome than non-aggressive papillary thyroid microcarcinoma subtypes? A multicenter cohort study. Horm. Metab. Res 10, 2032–5810 (2023)
S. Leboulleux, R.M. Tuttle, F. Pacini, M. Schlumberger, Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol. 4, 933–942 (2016)
doi: 10.1016/S2213-8587(16)30180-2
pubmed: 27550849
H.J. Moon, E.K. Kim, W.Y. Chung, J.H. Yoon, J.Y. Kwak, Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann. Surg. Oncol. 18, 1916–1923 (2011)
doi: 10.1245/s10434-011-1556-z
pubmed: 21267788
N. Chéreau, C. Buffet, C. Trésallet et al. Does extracapsular extension impact the prognosis of papillary thyroid microcarcinoma? Ann. Surg. Oncol. 21, 1659–1664 (2014)
doi: 10.1245/s10434-013-3447-y
pubmed: 24394985
C. Buffet, J.L. Golmard, C. Hoang et al. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur. J. Endocrinol. 167, 267–275 (2012)
doi: 10.1530/EJE-12-0105
pubmed: 22648965
R.Y. Song, H.S. Kim, K.H. Kang, Minimal extrathyroidal extension is associated with lymph node metastasis in single papillary thyroid microcarcinoma: a retrospective analysis of 814 patients. World J. Surg. Oncol. 20, 170 (2022)
doi: 10.1186/s12957-022-02629-8
pubmed: 35643530
pmcid: 9148524
F. Pacini, M. Schlumberger, H. Dralle et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol. 154, 787–803 (2006)
doi: 10.1530/eje.1.02158
pubmed: 16728537
M.B. Amin, S. Edge, F. Greene, et al. AJCC Cancer Staging Manual. 8th ed. Springer 881–889 (2017).
D.S. Cooper, G.M. Doherty et al. Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167e1214 (2009)
doi: 10.1089/thy.2009.0110
B.R. Haugen, E.K. Alexander, K.C. Bible et al. 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 (2016)
doi: 10.1089/thy.2015.0020
pubmed: 26462967
pmcid: 4739132
S.S. Zuhur, H. Aggul, M. Çelik et al. Can age at diagnosis and sex improve the performance of the american thyroid association risk stratification system for prediction of structural persistent and recurrent disease in patients with differentiated thyroid carcinoma? a multicenter study. Endocr. Pr. 28, 30–35 (2022)
doi: 10.1016/j.eprac.2021.09.001
D.P. Momesso, R.M. Tuttle, Update on differentiated thyroid cancer staging. Endocrinol. Metab. Clin. North Am. 43, 401–421 (2014)
doi: 10.1016/j.ecl.2014.02.010
pubmed: 24891169
A. Jang, M. Jin, C.A. Kim et al. Serum thyroglobulin testing after thyroid lobectomy in patients with 1-4 cm papillary thyroid carcinoma. Endocrine 81, 290–297 (2023)
doi: 10.1007/s12020-023-03346-2
pubmed: 36913171
H. Mehanna, T. Al-Maqbili, B. Carter et al. Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up. J. Clin. Endocrinol. Metab. 99, 2834–2843 (2014)
doi: 10.1210/jc.2013-2118
pubmed: 24828487
Y. Ito, C. Tomoda, T. Uruno et al. Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg. Today 36, 12–18 (2006)
doi: 10.1007/s00595-005-3090-8
pubmed: 16378187
I.D. Hay, T.R. Johnson, G.B. Thompson, T.J. Sebo, M.S. Reinalda, Minimal extrathyroid extension in papillary thyroid carcinoma does not result in increased rates of either cause-specific mortality or postoperative tumor recurrence. Surgery 159, 11–19 (2016)
doi: 10.1016/j.surg.2015.05.046
pubmed: 26514317
Y. Ito, C. Tomoda, T. Uruno et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J. Surg. 30, 780–786 (2006)
doi: 10.1007/s00268-005-0270-z
pubmed: 16411013
Z. Al-Qurayshi, N. Nilubol, R.P. Tufano, E. Kandil, Wolf in sheep’s clothing: Papillary thyroid microcarcinoma in the US. J. Am. Coll. Surg. 230, 484–491 (2020)
doi: 10.1016/j.jamcollsurg.2019.12.036
pubmed: 32220437
pmcid: 8916219
T. Diker-Cohen, D. Hirsch, I. Shimon et al. Impact of minimal extra-thyroid extension in differentiated thyroid cancer: Systematic review and meta-. J. Clin. Endocrinol. Metab. 103, 2100–2106 (2018)
doi: 10.1210/jc.2018-00081
R. Seifert, M.A. Schäfers, B. Heitplatz, L. Kerschke, B. Riemann, B. Noto, Minimal extrathyroid extension in papillary micro carcinoma of the thyroid is an independent risk factor for relapse through lymph node and distant metastases. J. Nucl. Med. 62, 1702–1709 (2021)
doi: 10.2967/jnumed.121.261898
pubmed: 33771902
pmcid: 8612207
Z.W. Baloch, S.L. Asa, J.A. Barletta et al. Overview of the 2022 WHO classification of thyroid neoplasms. Endocr. Pathol. 33, 27–63 (2022)
doi: 10.1007/s12022-022-09707-3
pubmed: 35288841
J.S. Park, J.W. Chang, L. Liu, S.N. Jung, B.S. Koo, Clinical implications of microscopic extrathyroidal extension in patients with papillary thyroid carcinoma. Oral. Oncol. 72, 183–187 (2017)
doi: 10.1016/j.oraloncology.2017.02.008
pubmed: 28222967
R.M. Tuttle, B. Haugen, N.D. Perrier, Updated american joint committee on cancer/ tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth ed.): what changed and why? Thyroid 27, 751–756 (2017)
doi: 10.1089/thy.2017.0102
pubmed: 28463585
pmcid: 5467103
X.M. Yu, Y. Wan, R.S. Sippel, H. Chen, Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann. Surg. 254, 653–660 (2011)
doi: 10.1097/SLA.0b013e318230036d
pubmed: 21876434
K.W. Schmid, S. Synoracki, H. Dralle et al. Proposal for an extended pTNM classification of thyroid carcinoma. Pathologe 40(Suppl 1), 18–24 (2019)
doi: 10.1007/s00292-018-0418-x
pubmed: 29459993
M.B. Amin, F.L. Greene, S.B. Edge et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J. Clin. 67, 93–99 (2017)
doi: 10.3322/caac.21388
pubmed: 28094848
R. Forleo, G. Grani, M. Alfò et al. (2021). Minimal extrathyroidal extension in predicting 1-year outcomes: A longitudinal multicenter study of low-to-intermediate-risk papillary thyroid carcinoma (ITCO#4). Thyroid 31(12), 1814–1821 (2021)
doi: 10.1089/thy.2021.0248
pubmed: 34541894
J. Lee, J.H. Park, C.R. Lee, W.Y. Chung, C.S. Park, Long-term outcomes of total thyroidectomy versus thyroid lobectomy for papillary thyroid microcarcinoma: comparative analysis after propensity score matching. Thyroid 23, 1408–1415 (2013)
doi: 10.1089/thy.2012.0463
pubmed: 23509895
S. Leboulleux, C. Bournaud, C.N. Chougnet et al. Thyroidectomy without radioiodine in patients with low-risk thyroid cancer. N. Engl. J. Med 386(10), 923–932 (2022)
doi: 10.1056/NEJMoa2111953
pubmed: 35263518
F. Pacini, D. Fuhrer, R. Elisei et al. 2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer? Eur. Thyroid J. 11(1), e210046 (2022)
doi: 10.1530/ETJ-21-0046
pubmed: 34981741
E. Ruel, S. Thomas, M. Dinan, J.M. Perkins, S.A. Roman, J.A. Sosa, Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J. Clin. Endocrinol. Metab. 100(4), 1529–1536 (2015). https://doi.org/10.1210/jc.2014-4332
doi: 10.1210/jc.2014-4332
pubmed: 25642591
pmcid: 4399282
J. Pachucki, L.A. Burmeister, Evaluation and treatment of persistent thyroglobulinemia in patients with well-differentiated thyroid cancer. Eur. J. Endocrinol. 137, 254e26 (1997)
M.F. Bates, M.R. Lamas, R.W. Randle et al. Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease? Surgery 163, 118–123 (2018)
doi: 10.1016/j.surg.2017.05.028
pubmed: 29128176
G. Sapuppo, M. Tavarelli, A. Belfiore, R. Vigneri, G. Pellegriti, Time to separate persistent from recurrent differentiated thyroid cancer: Different conditions with different outcomes. J. Clin. Endocrinol. Metab. 104, 258–265 (2019)
doi: 10.1210/jc.2018-01383
pubmed: 30165559