Auris Nasus Larynx 41 (2014) 548–551
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Recurrence pattern after conservative surgery for papillary thyroid carcinoma Kenya Kobayashi a,b,*, Shigeo Takenouchi a, Hiroki Mitani c, Tuyoshi Yoshida a a
Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan c Department of Head and Neck Surgery, The Cancer Institute Hospital, Japan b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 February 2014 Accepted 13 May 2014 Available online 26 June 2014
Objective: Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma. Methods: We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk. Results: The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p < 0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (4 cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis. Conclusion: Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Papillary thyroid carcinoma Conservative surgery Pattern of recurrence Risk-based treatment
1. Introduction Papillary thyroid carcinoma (PTC) generally shows indolent characteristics, but is associated with a high incidence of regional lymph node metastasis and multifocal tumors. Although riskbased treatment represents the optimal management strategy, the optimal extent of thyroidectomy and neck dissection remains controversial. According to the American Thyroid Association (ATA) guidelines, lobectomy may be sufficient for small (
Contents lists available at ScienceDirect
Auris Nasus Larynx journal homepage: www.elsevier.com/locate/anl
Recurrence pattern after conservative surgery for papillary thyroid carcinoma Kenya Kobayashi a,b,*, Shigeo Takenouchi a, Hiroki Mitani c, Tuyoshi Yoshida a a
Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan c Department of Head and Neck Surgery, The Cancer Institute Hospital, Japan b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 February 2014 Accepted 13 May 2014 Available online 26 June 2014
Objective: Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma. Methods: We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk. Results: The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p < 0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (4 cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis. Conclusion: Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Papillary thyroid carcinoma Conservative surgery Pattern of recurrence Risk-based treatment
1. Introduction Papillary thyroid carcinoma (PTC) generally shows indolent characteristics, but is associated with a high incidence of regional lymph node metastasis and multifocal tumors. Although riskbased treatment represents the optimal management strategy, the optimal extent of thyroidectomy and neck dissection remains controversial. According to the American Thyroid Association (ATA) guidelines, lobectomy may be sufficient for small (
