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Abstract
Background
We wanted to evaluate whether a minimal extrathyroid extension (METE) is associated with the clinicopathological parameters that are indicative of a poor prognosis, including lymph node metastasis, distant metastasis at the time of the initial diagnosis and tumor recurrence, in patients with papillary thyroid carcinoma (PTC), and especially in the patients with papillary thyroid microcarcinoma (PTMC).
Methods
We retrospectively evaluated the medical records of patients with PTC and who had undergone total thyroidectomy with/ without subsequent 131 I remnant ablation at the Korea Cancer Center Hospital from January 1998 through December 2005. A total of 557 patients with PTC were enrolled in the study. We excluded 13 patients with an unknown status of extension and 29 patients with massive ETE.
Results
Of the 515 patients, 401 were found to have a METE. We analyzed the 464 patients who were without distant metastasis at the time of the initial diagnosis and who had a follow-up duration of more than 6 months. METE was not significantly associated with tumor recurrence during the follow-up period (median follow-up period: 122 months, range: 6–142 months): 8% vs. 15% of the patients with and without METE had tumor recurrence, respectively (P = 0.069 by the log–rank test). We analyzed the effect of tumor size in the patients with METE. Size was not significantly associated with tumor recurrence (P = 0.374 by the log–rank test).
References
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Fig. 1.
Disease-free survival according to extrathyroid extension in 464 patients who were without distant metastasis at the time of the initial diagnosis. The Kaplan-Meier method for recurrence with the log rank test was used for statistical comparisons.
Fig. 2.
Disease-free survival according to extrathyroid extension in the 429 patients with tumor smaller than 4 cm and without distant metastasis at the time of the initial diagnosis. The Kaplan-Meier method for recurrence with the log rank test was used for statistical comparisons.
Fig. 3.
Disease-free survival according to extrathyroid extension in the 121 patients with papillary thyroid microcarcinoma and without distant metastasis at the time of the initial diagnosis. The Kaplan-Meier method for recurrence with the log rank test was used for statistical comparisons.
Fig. 4.
Disease-free survival according to tumor size in the 358 patients with tumor with minimal extrathyroid extension and without distant metastasis at the time of the initial diagnosis. The Kaplan-Meier method for recurrence with the log rank test was used for statistical comparisons.
Table 1.
The clinicopathological characteristics according to the presence of minimal extrathyroid extension
| Clinicopathological parameters | METE- (n = 114) | METE+ (n = 401) | P-value |
|---|---|---|---|
| Age (years) | 45 ± 12 | 47 ± 13 | 0.057‡ |
| Gender (M:F) | 16:98 | 81:320 | 0.174§ |
| Size (cm) | 1.5 ± 1.3 | 2.2 ± 1.5 | < 0.001 |
| Lymph node metastasis | 0.015 | ||
| No metastasis | 41 (36) | 93 (23) | |
| Metastasis to central cervical lymph node* | 45 (40) | 168 (42) | |
| Metastasis to lateral cervical lymph node† | 28 (24) | 140 (35) | |
| Distant metastasis | 0.059§ | ||
| Absent | 112 (98) | 376 (94) | |
| Present | 2 (2) | 25 (6) | |
| 131 I Remnant ablation | 0.057§ | ||
| No | 11 (10) | 20 (5) | |
| Yes | 103 (90) | 381 (95) |
* Central cervical lymph nodes are defined as lymph nodes of level VI (i.e., the pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes), and these are classified as N1a in 2010 TNM staging.
Table 2.
Multivariate analysis of the associations between minimal extrathyroid extension and various clinicopathological parameters
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