Clinical Significance of Tumor Size in Papillary Thyroid Microcarcinoma: a Meta-Analysis

Su-jin Kim; Kyungsik Kim; Young peck Song; Ho Kyung Sung; Kyu Eun Lee; Sue K. Park

doi:10.16956/jes.2018.18.2.142

Journal List > J Endocr Surg > v.18(2) > 1097248

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Kim, Song, Sung, Lee, and Park: Clinical Significance of Tumor Size in Papillary Thyroid Microcarcinoma: a Meta-Analysis

Original Article

J Endocr Surg. 2018;18(2):142-154.

Published online: 5 June 2018

DOI: https://doi.org/10.16956/jes.2018.18.2.142

Clinical Significance of Tumor Size in Papillary Thyroid Microcarcinoma: a Meta-Analysis

Su-jin Kim^1,^2,³

, Kyungsik Kim^2,^4,⁵

, Young peck Song^1,^2,³

, Ho Kyung Sung⁴

, Kyu Eun Lee^1,^2,³

, Sue K. Park^1,^2,³

¹Department of Surgery, Seoul National University Hospital & College of Medicine, Seoul, Korea

²Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

³Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea

⁴Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea

⁵Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea

Correspondence to Kyu Eun Lee Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: kyu.eun.lee.md@gmail.com

Su-jin Kim, Kyungsik Kim, and Young peck Song equally contributed to this work.

This research was supported by the Research Resettlement Fund for the new faculty of Seoul National University.

Received 20 February 201827 February 2018 Accepted 10 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

To determine whether the tumor size associtates with aggressive clinicopathologic features and tumor recurrence in patients with papillary thyroid microcarcinoma (PTMC) who had undergone thyroidectomy. Clinical significance of tumor size in patients with PTMC is still controversial.

Methods

A search of PubMed, MEDLINE, and EMBASE identified the clinical studies that examined the association of subgroups classified by tumor size (5 mm) in surgical specimens with aggressive clinicopathologic features, and clinical outcomes between 1976 and 2017.

Seven hundred twenty relevant studies were searched, and the authors selected 34 studies, including 12,134 PTMC cases. Random effects meta-analyses were performed using odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs).

Results

In 34 studies, compared with the patients with small PTMC, the patients with large PTMC had a higher risk of multifocality (OR, 1.97; 95% CI, 1.61–2.40; I², 40.7%), extrathyroidal extension (OR, 3.42; 95% CI, 2.46–4.75; I², 64.9%), and lymph node metastasis (OR, 2.45; 95% CI, 1.79–3.37; I², 80.5%). In 10 studies, patient with large PTMC had 1.65-fold increased risk of locoregional recurrence (95% CI, 1.20–2.27; I², 0.0%).

Conclusion

This meta-analysis showed that tumor size in PTMC is associated with high-risk clinicopathologic characteristics and tumor recurrence. These findings may be helpful to decide treatment plans for patients with PTMC larger than 5 mm.

Keywords: Papillary thyroid microcarcinoma, Meta-analysis

REFERENCES

1.Hedinger CE., Williams ED., Sobin LH. Histological Typing of Thyroid Tumours. 2nd ed.Berlin: Springer-Verlag;1988.

2.Ito Y., Tomoda C., Uruno T., Takamura Y., Miya A., Kobayashi K, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006. 30:91–9.

3.Jacquot-Laperrière S., Timoshenko AP., Dumollard JM., Peoc'h M., Estour B., Martin C, et al. Papillary thyroid microcarcinoma: incidence and prognostic factors. Eur Arch Otorhinolaryngol. 2007. 264:935–9.

4.Roti E., degli Uberti EC., Bondanelli M., Braverman LE. Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur J Endocrinol. 2008. 159:659–73.

5.Noguchi S., Yamashita H., Uchino S., Watanabe S. Papillary microcarcinoma. World J Surg. 2008. 32:747–53.

6.Mazzaferri EL. Managing small thyroid cancers. JAMA. 2006. 295:2179–82.

7.Pelizzo MR., Boschin IM., Toniato A., Piotto A., Bernante P., Pagetta C, et al. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur J Surg Oncol. 2006. 32:1144–8.

8.Zhao Q., Ming J., Liu C., Shi L., Xu X., Nie X, et al. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol. 2013. 20:746–52.

9.Kim SY., Park JE., Lee YJ., Seo HJ., Sheen SS., Hahn S, et al. Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol. 2013. 66:408–14.

10.McDonald JH. The Handbook of biological statistics [Internet]. Baltimore (MA): Sparky House Publishing;2007. [cited 2011 Mar 2]. Available from. http://udel.edu/~mcdonald/statpermissions.html.

11.Higgins JP., Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002. 21:1539–58.

12.Egger M., Davey Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997. 315:629–34.

13.Yoon KS., Oh SS., Park SG., Chung ES. Diagnosis and treatment of papillary thyroid microcarcinoma. Korean J Head Neck Oncol. 1998. 14:228–35.

14.Chow SM., Law SC., Au SK., Mang O., Yau S., Yuen KT, et al. Changes in clinical presentation, management and outcome in 1348 patients with differentiated thyroid carcinoma: experience in a single institute in Hong Kong, 1960–2000. Clin Oncol (R Coll Radiol). 2003. 15:329–36.

15.Wada N., Duh QY., Sugino K., Iwasaki H., Kameyama K., Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003. 237:399–407.

16.Cho B., Choi J., Kim JH. A clinical review of papillary microcarcinoma of the thyroid. Korean J Endocr Surg. 2006. 6:87–93.

17.Han IW., Choe JH., Han W., Noh DY., Oh SK., Youn YK. Papillary thyroid microcarcinomas: experience at a single institute. Korean J Endocr Surg. 2006. 6:63–7.

18.Lee J., Rhee Y., Lee S., Ahn CW., Cha BS., Kim KR, et al. Frequent, aggressive behaviors of thyroid microcarcinomas in Korean patients. Endocr J. 2006. 53:627–32.

19.Roti E., Rossi R., Trasforini G., Bertelli F., Ambrosio MR., Busutti L, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006. 91:2171–8.

20.Park HL., Kwak JY., Kang SS., Kim DY., Kang HG., Shim JY, et al. The analysis of tumor aggressiveness according to tumor size in occult papillary thyroid carcinoma. J Korean Surg Soc. 2007. 73:470–5.

21.Pakdaman MN., Rochon L., Gologan O., Tamilia M., Garfield N., Hier MP, et al. Incidence and histopathological behavior of papillary microcarcinomas: study of 429 cases. Otolaryngol Head Neck Surg. 2008. 139:718–22.

22.Kim KM., Cho MS., Choi YH., Bae KS., Kang SJ. The prognostic factors and therapeutic strategy for papillary thyroid microcarcinoma. Korean J Endocr Surg. 2008. 8:177–82.

23.Kim TY., Hong SJ., Kim JM., Kim WG., Gong G., Ryu JS, et al. Prognostic parameters for recurrence of papillary thyroid microcarcinoma. BMC Cancer. 2008. 8:296.

24.Lee SH., Lee SS., Jin SM., Kim JH., Rho YS. Predictive factors for central compartment lymph node metastasis in thyroid papillary microcarcinoma. Laryngoscope. 2008. 118:659–62.

25.Tae K., Chung JH., Lee YS., Choi YY., Park YS., Kim DS, et al. Characteristics of papillary thyroid microcarcinoma according to tumor size. J Korean Thyroid Assoc. 2008. 1:142–7.

26.Yoo YS., Kim SS., Mun SP., Kim KJ., Chang JH., Min YD, et al. Clinicopathologic findings of micropapillary carcinomas, according to tumor size. J Korean Surg Soc. 2009. 76:348–54.

27.Kim YW., Wang SG., Lee JC., Lee BJ., Lee JW., Kim YK, et al. Clinically related factors and features of central compartment neck lymph nodes in thyroid micropapillary carcinoma. Korean J Otorhinolaryngol-Head Neck Surg. 2009. 52:232–6.

28.Friguglietti CU., Dutenhefner SE., Brandao LG., Kulcsar MA. Classification of papillary thyroid microcarcinoma according to size and fine-needle aspiration cytology: behavior and therapeutic implications. Head Neck. 2011. 33:696–701.

29.Kim JW., Lee DY., Cho YU., Kim CH., Oh YS., Kim YM. Clinical characteristics of papillary thyroid microcarcinoma. Korean J Otorhinolaryngol-Head Neck Surg. 2010. 53:166–71.

30.Lee NS., Bae JS., Jeong SR., Jung CK., Lim DJ., Park WC, et al. Risk factors of lymph node metastasis in papillary thyroid microcarcinoma. J Korean Surg Soc. 2010. 78:82–6.

31.Lombardi CP., Bellantone R., De Crea C., Paladino NC., Fadda G., Salvatori M, et al. Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg. 2010. 34:1214–21.

32.Lee KJ., Cho YJ., Kim SJ., Lee SC., Kim JG., Ahn CJ, et al. Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J Surg. 2011. 35:318–23.

33.Buffet C., Golmard JL., Hoang C., Trésallet C., Du Pasquier Fédiaevsky L., Fierrard H, et al. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur J Endocrinol. 2012. 167:267–75.

34.Vasileiadis I., Karakostas E., Charitoudis G., Stavrianaki A., Kapetanakis S., Kouraklis G, et al. Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients. Eur J Clin Invest. 2012. 42:657–64.

35.Zhou YL., Gao EL., Zhang W., Yang H., Guo GL., Zhang XH, et al. Factors predictive of papillary thyroid microcarcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol. 2012. 10:67.

36.Ardito G., Revelli L., Giustozzi E., Salvatori M., Fadda G., Ardito F, et al. Aggressive papillary thyroid microcarcinoma: prognostic factors and therapeutic strategy. Clin Nucl Med. 2013. 38:25–8.

37.Kim KE., Kim EK., Yoon JH., Han KH., Moon HJ., Kwak JY. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg. 2013. 37:385–91.

38.Zheng X., Wei S., Han Y., Li Y., Yu Y., Yun X, et al. Papillary microcarcinoma of the thyroid: clinical characteristics and BRAF(V600E) mutational status of 977 cases. Ann Surg Oncol. 2013. 20:2266–73.

39.Karatzas T., Vasileiadis I., Charitoudis G., Karakostas E., Tseleni-Balafouta S., Kouraklis G. Bilateral versus unilateral papillary thyroid microcarcinoma: predictive factors and associated histopathological findings following total thyroidectomy. Hormones (Athens). 2013. 12:529–36.

40.Kim E., Choi JY. Koo DH, Lee KE, Youn YK. Differences in the characteristics of papillary thyroid microcarcinoma ≤5 mm and >5 mm in diameter. Head Neck. 2015. 37:694–7.

41.Lee J., Song Y., Soh EY. Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci. 2014. 29:48–52.

42.Zeng RC., Zhang W., Gao EL., Cheng P., Huang GL., Zhang XH, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck. 2014. 36:101–6.

43.Al-Qahtani KH., Al Asiri M., Tunio MA., Aljohani NJ., Bayoumi Y., Fatani H, et al. Adjuvant Radioactive iodine 131 ablation in papillary microcarcinoma of thyroid: Saudi Arabian experience. J Otolaryngol Head Neck Surg. 2015. 44:51.

44.Usluogullari CA., Onal ED., Ozdemir E., Ucler R., Kiyak G., Ersoy PE, et al. A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma. Minerva Endocrinol. 2015. 40:15–22.

Fig. 1.

Flow chart for article selection for the meta-analysis.

Fig. 2.

Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the high-risk factors: (A) multifocality, (B) bilaterality, (C) extrathyroidal extension, (D) LN metastasis, (E) CLN metastasis, and (F) LLN metastasis. PTMC = papillary thyroid microcarcinoma; LN = lymph node; CLN = central lymph node; LLN = lateral lymph node; OR = odds ratio; CI = confidence interval.

Fig. 2.

(Continued) Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the high-risk factors: (A) multifocality, (B) bilaterality, (C) extrathyroidal extension, (D) LN metastasis, (E) CLN metastasis, and (F) LLN metastasis. PTMC = papillary thyroid microcarcinoma; LN = lymph node; CLN = central lymph node; LLN = lateral lymph node; OR = odds ratio; CI = confidence interval.

Fig. 3.

Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the risk of tumor recurrence: (A) LR and (B) DM recurrence. PTMC = papillary thyroid microcarcinoma; LR = locoregional recurrence; DM = distant metastasis; RR = relative risk; CI = confidence interval.

Table 1.

Characteristics of the 34 studies included in the meta-analysis

Study	No. of patients^∗	Gender (M/F)	Age, mean	Period of study	Multifocal tumors^∗	Bilateral tumors^∗	Extrathyroidal extension^∗	LN metastasis^∗	Recurrence^∗	Country	Incidence (ASR)^†	Study quality
Yoon et al., 1998 (13)	72 (32/40)	10/62	45.0	1985–1995	−	−		7/16	−	Korea	35.4	11
Chow et al., 2003 (14)	203 (70/133)	27/176	46.8	1960–1999	18/45	−	3/39	18/32	4/8 (LR), 0/3 (DM)	Hong Kong	1.4	13
Wada et al., 2003 (15)	259 (61/198)	29/230	48.0	1988–1998	−	−		34/146	−	Japan	3.1	13
Cho et al., 2006 (16)	134 (39/95)	11/123	−	2003–2006	3/24	−	7/29	11/38	−	Korea	35.4	13
Han et al., 2006 (17)	350 (147/203)	54/296	46.5	1990–2004	−	−	−	−	4/22	Korea	35.4	13
Lee et al., 2006 (18)	300 (62/238)	27/273	46.1	2004	−	−	7/77	16/73	−	Korea	35.4	13
Pelizzo et al., 2006 (7)	403 (169/234)	66/337	−	1990–2004	−	−	−	−	6/18	Italy	9.1	12
Roti et al., 2006 (19)	243 (86/157)	46/197	51.5	1993–2002	−	−	−	2/30	0/4	Italy	9.1	13
Park et al., 2007 (20)	218 (71/147)	−	−	2001–2007	18/58	5/31	10/60	4/36	−	Korea	35.4	12
Pakdaman et al., 2008 (21)	429 (274/155)	−	−	2002–2007	140/110	74/77 (140/110)^¶	25/39	−	−	Canada	9.4	12
Kim et al., 2008 (22)	254 (72/182)	41/213	48.1	1985–2002	4/8	−	2/12	9/21	1/9	Korea	35.4	13
Kim et al., 2008 (23)	307 (49/258)	32/275	−	1996–2002	9/89	−	−	−	−	Korea	35.4	13
Lee et al., 2008 (24)	52 (26/26)	7/45	47.6	2000–2005	−	−	−	1/15^†	−	Korea	35.4	14
Tae et al., 2008 (25)	142 (62/80)	31/111	48.3	2000–2006	10/17	−	7/22	8/16	−	Korea	35.4	13
Yoo et al., 2009 (26)	165 (62/103)	13/152	46.4	2002–2006	4/17	1/6	−	8/22	0/4	Korea	35.4	12
Kim et al., 2009 (27)	161 (52/109)	24/137	48.3	2003–2007	11/34	10/27	18/58	19/56^†; 3/12^§	-	Korea	35.4	14
Friguglietti et al., 2011 (28)	448 (173/275)	52/396	−	2002–2008	26/45	−	23/41	10/45	−	Brazil	2.9	13
Kim et al., 2010 (29)	179 (78/101)	16/163	47.4	1996–2006	8/27 (29/71)^¶	4/14 (29/71)^¶	3/43	−	−	Korea	35.4	12
Lee et al., 2010 (30)	335 (125/220)	41/294	48.0	2006–2008	−	−	−	16/72	−	Korea	35.4	14
Lombardi et al., 2010 (31)	933 (459/474)	197/736	−	2002–2007	−	−	16/73	12/50	2/7 (100/187)^¶	Italy	9.1	13
Lee et al., 2011 (32)	275 (106/169)	13/262	−	2007–2009	29/61	16/40 (79/149)^¶	18/44	29/71^†	−	Korea	35.4	13
Buffet et al., 2012 (33)	707 (138/569)	289/418	47.2	1960–2007	−	−	−	56/233	−	France	0.7	15
Vasileiadis et al., 2012 (34)	276 (202/74)	54/222	−	2002–2008	60/42	29/35	3/17	7/16	−	Greece	1.8	13
Zhou et al., 2012 (35)	211 (67/144)	32/179	49.0	2010–2011	−	10/44	−	8/52^† (23/99)^¶	−	China	1.4	14
Ardito et al., 2013 (36)	149 (92/57)	30/119	47.6	2000–2005	−	−	−	−	18/10	Italy	9.1	14
Kim et al., 2013 (37)	483 (213/270)	68/415	45.2	2008	−	−	−	40/99^†	−	Korea	35.4	13
Zhao et al., 2013 (8)	212 (69/143)	36/176	45.1	2003–2011	−	−	−	17/62	−	China	1.4	14
Zheng et al., 2013 (38)	977 (632/345)	223/754	46.0	2001–2010	164/159	86/133	−	61/168	−	China	1.4	16
Karatzas et al., 2013 (39)	319 (249/70)	58/261	50.3	2001–2008	−	44/33	−	−	−	Greece	1.8	14
Kim et al., 2014 (40)	205 (83/122)	36/169	47.2	2005	19/33	13/25	18/52 (81/122)^¶	14/26 (39/70)^¶	2/7	Korea	35.4	17
Lee et al., 2014 (41)	2,018 (857/1,161)	297/1,721	45.3	1994–2010	−	−	−	−	13/28	Korea	35.4	17
Zeng et al., 2014 (42)	141 (12/129)	37/104	44.0	2004–2011	−	−	−	2/41^§	−	China	1.4	16
Al-Qahtani et al., 2015 (43)	326 (161/65)	55/271	42.9	2000–2012	36/89	−	16/46	15/27	6/17, 4/9 (LR),2/8 (DM)	Saudi Arabia	4.4	15
Usluogullari et al., 2015 (44	) 248 (127/121)	47/201	47.8	2007–2012	28/40	17/28	7/21	2/16	4/6	Turkey	10.8	15

LN = lymph node; ASR = age-standardized rate; LR = locoregional recurrence; DM = distant metastasis; CLN = central lymph node; LLN = lateral lymph node.

^∗ The number of patients with tumor size less than 5 mm/over 5 mm was expressed in each cell

^† ASR per 100, 000 of thyroid cancer from GLOBACAN 2008 CLN metastasis

^§ LLN metastasis

^¶ Evaluated number of patients (less than 5 mm/over 5 mm).

Table 2.

Subgroup analyses categorized by incidence rate of thyroid cancer, study quality, and published year of the articles; risk with high-risk factors, and tumor recurrence in large PTMC compared with small PTMC

Outcome	Studies (No.)	Summary	I² (%)	P
Outcome	Studies (No.)	Summary	I² (%)	Heterogeneity	Begg	Egger
Multifocality
All studies	17	1.97 (1.61–2.40)	40.7	0.04	0.59	0.27
Study QS
≥14	4	2.45 (1.71–3.51)	53.6	0.09	0.73	0.77
<14	13	1.78 (1.43–2.21)	20.8	0.23	0.86	0.93
Incidence rate
High	13	1.98 (1.56–2.50)	29.9	0.15	0.86	0.46
Low	4	1.93 (1.25–2.98)	69.4	0.02	0.73	0.51
Published year
≥2011	6	2.23 (1.61–3.09)	62.8	0.02	0.26	0.53
<2011	11	1.76 (1.42–2.18)	0.0	0.47	1.00	0.96
Combination
High incidence and QS ≥14	3	2.38 (1.29–4.41)	68.7	0.04	1.00	0.46
Low incidence and QS ≥14	1	2.44 (1.85–3.22)
High incidence and ≥2011	4	1.95 (1.13–3.37)	74.2	0.01	0.31	0.18
Low incidence and ≥2011	2	2.56 (2.00–3.28)	0.0	0.44	1.00
High incidence, ≥2011 and QS ≥14	2	2.71 (1.18–6.18)	79.8	0.03	1.00
Low incidence, ≥2011 and QS ≥14	1	2.44 (1.85–3.22)
Bilaterality
All studies	12	2.39 (1.87–3.06)	40.0	0.07	0.84	0.68
Study QS
≥14	6	2.29 (1.70–3.09)	35.9	0.17	0.26	0.51
<14	6	2.56 (1.61–4.05)	51.7	0.07	1.00	0.93
Incidence rate
High	8	1.84 (1.40–2.40)	0.0	0.77	0.71	0.63
Low	4	3.31 (2.22–4.96)	57.8	0.06	0.73	0.33
Published year
≥2011	7	2.52 (1.79–3.54)	59.4	0.02	1.00	0.88
<2011	5	2.07 (1.44–2.98)	0.0	0.63	1.00	0.80
Combination
High incidence and QS ≥14	3	1.59 (1.04–2.43)	0.0	0.74	1.00	0.31
Low incidence and QS ≥14	3	2.80 (2.02–3.86)	27.2	0.25	1.00	0.62
High incidence and ≥2011	3	1.59 (1.07–2.36)	0.0	0.75	1.00	0.68
Low incidence and ≥2011	4	3.31 (2.22–4.96)	57.8	0.06	0.73	0.33
High incidence, ≥2011 and QS ≥14	2	1.68 (1.02–2.75)	0.0	0.51	1.00
Low incidence, ≥2011 and QS ≥14	3	2.80 (2.02–3.86)	27.2	0.25	1.00	0.62
Extrathyroidal extension
All studies	16	3.42 (2.46–4.75)	64.9	<0.01	0.14	0.05
Study QS
≥14	4	2.85 (2.02–4.02)	0.0	0.70	0.73	0.78
<14	12	3.78 (2.40–5.93)	73.3	<0.01	0.24	0.08
Incidence rate
High	13	3.25 (2.51–4.20)	33.6	0.11	1.00	0.52
Low	3	5.58 (0.81–38.26)	91.3	<0.01	0.29	0.11
Low Published year	3	5.58 (0.81–38.26)	91.3	<0.01	0.29	0.11
≥2011	5	3.52 (1.93–6.42)	68.8	0.01	0.22	0.07
<2011	11	3.41 (2.25–5.17)	66.6	<0.01	0.53	0.23
Combination
High incidence and QS ≥14
Low incidence and QS ≥14	4	2.85 (2.02–4.02)	0.0	0.70	0.73	0.78
High incidence and ≥2011	0
Low incidence and ≥2011	4	2.63 (1.87–3.70)	4.1	0.37	0.73	0.56
High incidence, ≥2011 and QS ≥14	1	19.78 (6.00–69.90)	−	−	−	−
Low incidence, ≥2011 and QS ≥14	3	3.13 (2.11–4.86)	0.0	0.76	0.75	0.79
LN metastasis
All studies	26	2.45 (1.79–3.37)	80.5	<0.01	0.11	0.97
Study QS
≥14	10	3.14 (1.63–6.06)	89.2	<0.01	0.37	0.96
<14	16	2.13 (1.58–2.87)	60.3	<0.01	0.62	0.57
Incidence rate
High	18	2.24 (1.72–2.91)	51.5	0.01	0.54	0.15
Low	8	2.66 (1.23–5.78)	92.1	<0.01	0.54	0.73
Published year
≥2011	11	2.68 (1.54–4.67)	88.8	<0.01	0.35	0.83
<2011	15	2.23 (1.59–3.11)	59.9	<0.01	0.37	0.12
Combination
High incidence and QS ≥14	5	3.30 (1.69–6.41)	62.1	0.03	0.46	0.04
Low incidence and QS ≥14	5	2.61 (0.89–7.70)	94.5	<0.01	0.81	0.75
High incidence and ≥2011	5	2.09 (1.39–3.15)	46.8	0.11	1.00	0.74
Low incidence and ≥2011	6	3.11 (1.19–8.12)	93.4	<0.01	0.71	0.89
High incidence, ≥2011 and QS ≥14	2	3.68 (0.78–17.43)	73.1	0.05	1.00
Low incidence, ≥2011and QS ≥14	5	2.61 (0.89–7.70)	94.5	<0.01	0.81	0.75
CLN metastasis
All studies	10	2.54 (1.79–3.59)	55.9	0.02	0.05	0.01
Study QS
≥14	4	2.91 (1.45–5.84)	57.5	0.07	0.73	0.23
<14	6	2.42 (1.58–3.73)	61.1	0.03	0.45	0.08
Incidence rate
High	8	2.28 (1.62–3.19)	48.5	0.06	0.17	0.02
Low	2	3.99 (1.10–14.43)	73.3	0.05	1.00	−
Published year
<2011	6	2.59 (1.53–4.39)	62.4	0.02	0.13	0.04
≥2011	4	2.58 (1.53–4.34)	57.4	0.07	0.73	0.34
Combination
High incidence and QS ≥14	3	3.58 (1.34–9.57)	70.5	0.03	1.00	0.31
Low incidence and QS ≥14	2	1.27 (0.67–2.40)	46.6	0.17	1.00	−
High incidence and ≥2011	2	2.00 (1.40–2.87)	0.0	0.83	1.00	0.89
Low incidence and ≥2011	2	3.99 (1.10–14.43)	73.3	0.05	1.00	−
High incidence, ≥2011 and QS ≥14	3	3.58 (1.34–9.57)	70.5	0.03	1.00	0.31
Low incidence, ≥2011 and QS ≥14	2	1.27 (0.67–2.40)	46.6	0.17	1.00	−
LLN metastasis
All studies	3	1.43 (0.78–2.65)	0.0	0.61	0.30	0.06
LR^∗
All studies	10	1.65 (1.20–2.27)	0.0	0.57	0.59	0.20
Study QS
≥14	5	1.41 (0.95–2.11)	0.0	0.59	0.81	0.30
<14	5	2.22 (1.30–3.77)	0.0	0.55	1.00	0.96
Incidence rate
High	9	1.71 (1.23–2.39)	0.0	0.54	0.60	0.14
Low	1	1.05 (0.33–3.36)
Published year
≥2011	5	1.41 (0.93–2.09)	0.0	0.59	0.81	0.30
<2011	5	2.21 (1.30–3.76)	0.0	0.55	1.00	0.96
Combination
High incidence and QS ≥14	5	1.41 (0.93–2.09)	0.0	0.59	0.81	0.30
Low incidence and QS ≥14	0
High incidence and ≥2011	5	1.41 (0.93–2.09)	0.0	0.59	0.81	0.30
Low incidence and ≥2011	0
High incidence, ≥2011 and QS ≥14	5	1.41 (0.93–2.09)	0.0	0.59	0.81	0.30
Low incidence, ≥2011 and QS ≥14	0
DM recurrence^∗
All studies	2	1.37 (0.18–10.49)	72.0	0.06	1.00

PTMC = papillary thyroid microcarcinoma; QS = quality score; DM = distant metastasis; LN = lymph node; CLN = central lymph node; LLN = lateral lymph node; LR = locoregional recurrence; RR = relative risk; CI = confidence interval.

^∗ Summary data shown are RR (95% CI).

TOOLS

Similar articles