Management of 2–4 cm Papillary Thyroid Carcinoma: Risk of Recurrence Compared to 1–2 cm and >4 cm
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Clinicians still debate how to manage 2–4 cm papillary thyroid carcinoma (PTC). To understand the characteristics and prognosis of these tumors, we compared clinicopathological prognostic factors and prognosis among 1–2 cm, 2–4 cm, and >4 cm PTC. Methods: We retrospectively reviewed the medical records of 2,079 patients with primary PTC >1 cm who were diagnosed between 2002 and 2017. Results: The patients' mean age was 47.9±12.5 years, and 83.2% were women. The follow-up period was 81.1±41.8 months. The tumor recurred in 138 patients (6.6%), and thyroid cancer-related death developed in 3 cases (0.1%). As tumor size increased, so did the proportion of male patients, lymphovascular invasion, resection margin positivity, lymph node (LN) metastasis, metastasis in >5 LNs, T4, N stage, and M stage. Recurrence increased linearly according to tumor size, as did distant metastasis as first recurrence and progression to distant metastasis. Tumor size, N stage, metastasis in >5 LNs, and LN metastasis were significant independent risk factors for PTC recurrence. The recurrence rate of 2–4 cm PTC was 13.4%, while the risk of recurrence was 3 times higher than in 1–2 cm PTC. The 5-year recurrence free survival (RFS) rates of 1–2 cm, 2–4 cm, and >4 cm PTC were 97.0%, 88.0%, and 74.0%, respectively, while the 10-year RFS rates were 95.0%, 84.0%, and 71.0%. Conclusion: The 2–4 cm PTC may be pathologically distinct from 1–2 cm PTC and should be treated differently.
Abstract
Purpose: Clinicians still debate how to manage 2–4 cm papillary thyroid carcinoma (PTC). To understand the characteristics and prognosis of these tumors, we compared clinicopathological prognostic factors and prognosis among 1–2 cm, 2–4 cm, and >4 cm PTC. Methods: We retrospectively reviewed the medical records of 2,079 patients with primary PTC >1 cm who were diagnosed between 2002 and 2017. Results: The patients' mean age was 47.9±12.5 years, and 83.2% were women. The follow-up period was 81.1±41.8 months. The tumor recurred in 138 patients (6.6%), and thyroid cancer-related death developed in 3 cases (0.1%). As tumor size increased, so did the proportion of male patients, lymphovascular invasion, resection margin positivity, lymph node (LN) metastasis, metastasis in >5 LNs, T4, N stage, and M stage. Recurrence increased linearly according to tumor size, as did distant metastasis as first recurrence and progression to distant metastasis. Tumor size, N stage, metastasis in >5 LNs, and LN metastasis were significant independent risk factors for PTC recurrence. The recurrence rate of 2–4 cm PTC was 13.4%, while the risk of recurrence was 3 times higher than in 1–2 cm PTC. The 5-year recurrence free survival (RFS) rates of 1–2 cm, 2–4 cm, and >4 cm PTC were 97.0%, 88.0%, and 74.0%, respectively, while the 10-year RFS rates were 95.0%, 84.0%, and 71.0%. Conclusion: The 2–4 cm PTC may be pathologically distinct from 1–2 cm PTC and should be treated differently.
참고문헌 (16)
- Cooper DS, "Management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 16, pp.109~142 (2006)
- Cooper DS, "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 19, pp.1167~1214 (2009)
- Haugen BR, "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, pp.1~133 (2016)
- Marques P, "Retrospective analysis of 255 papillary thyroid carcinomas ≤2 cm : clinicohistological features and prognostic factors", Eur Thyroid J, 3, pp.258~263 (2014)
- Perrino M, "Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers < or =2 cm", Endocr Relat Cancer, 16, pp.201~210 (2009)
- Kluijfhout WP, "Frequency of high-risk characteristics requiring total thyroidectomy for 1-4 cm well-differentiated thyroid cancer", Thyroid, 26, pp.820~824 (2016)
- Anda Apiñániz E, "The extent of surgery for low-risk 1-4 cm papillary thyroid carcinoma : a catch-22 situation. A retrospective analysis of 497 patients based on the 2015 ATA guidelines recommendation 35", Endocrine, 70, pp.538~543 (2020)
- Liu J, "Total thyroidectomy versus lobectomy for intermediaterisk papillary thyroid carcinoma : a single-institution matched-pair analysis", Oral Oncol, 90, pp.17~22 (2019)
- Song E, "Lobectomy is feasible for 1–4 cm papillary thyroid carcinomas : a 10-year propensity score matched-pair analysis on recurrence", Thyroid, 29, pp.64~70 (2019)
- Park SY, "Prognostic significance of gross extrathyroidal extension invading only strap muscles in differentiated thyroid carcinoma", Br J Surg, 105, pp.1155~1162 (2018)
- Rajjoub SR, "Thyroid lobectomy is not sufficient for T2 papillary thyroid cancers", Surgery, 163, pp.1134~1143 (2018)
- Lee YM, "Dynamic risk stratification in papillary thyroid carcinoma measuring 1 to 4 cm", J Surg Oncol, 118, pp.636~643 (2018)
- Choi JB, "Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy", Head Neck, 41, pp.56~63 (2019)
- Chan S, "Systematic review of recurrence rate after hemithyroidectomy for low-risk well-differentiated thyroid cancer", Eur Thyroid J, 9, pp.73~84 (2020)
- Zhang C, "Total thyroidectomy versus lobectomy for papillary thyroid cancer: a systematic review and meta-analysis", Medicine(Baltimore), 99, pp.e19073~ (2020)
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Thyroid Carcinoma (Version 2.2020, July 15, 2020), "National Comprehensive Cancer Network", National Comprehensive Cancer Network, ~ (2020)