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Long-term oncologic outcomes of papillary thyroid mircrocarcinoma according to the presence of clinically apparent lymph node metastasi: a large retrospective analysis of 5,348 patients

Authors
 Jung Bum Choi  ;  Woo Kyung Lee  ;  Seul Gi Lee  ;  Haengrang Ryu  ;  Cho Rok Lee  ;  Sang Wook Kang  ;  Jong Ju Jeong  ;  Kee-Hyun Nam  ;  Eun Jig Lee  ;  Woong Youn Chung  ;  Young Suk Jo  ;  Jandee Lee 
Citation
 Cancer Management and Research, Vol.10 : 2883-2891, 2018 
Journal Title
 Cancer Management and Research 
Issue Date
2018
Keywords
active surveillance ; lymphatic metastasis ; neoplasm recurrence ; papillary thyroid microcarcinoma
Abstract
Purpose: Active surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) may reduce the risk of overtreatment of clinically insignificant cancer. However, the absence of predictor for the progression of PTMC resulted in treatment delay and potentially compromising cure of aggressive disease. Therefore, to anticipate potential damage of delayed surgery, we investigated the oncologic outcomes of patients with low-risk PTMC initially eligible for AS except clinically apparent lymph node metastasis (LNM), imitating delayed surgery with neck dissection. Materials and methods: A total of 5,348 patients, enrolled between 1987 and 2016, with low-risk PTMC initially eligible for AS were included regardless of LNM. We classified our study patients into two groups: Group I, lobectomy with prophylactic central cervical node dissection; Group II, total thyroidectomy with modified radical neck dissection for LNM. In addition, we investigated the oncological outcomes of patients with second-wave surgery due to lateral lymph node recurrence (Group III, subgroup of Group I). Results: Group I showed more favorable clinicopathological characteristics compared with Group II. In Group I, only 29 (0.58%) of 4,927 patients underwent second-wave surgery with neck dissection for lateral lymph node recurrences, whereas in Group II, all 22 (5.23%) of 421 patients underwent second-wave selective node dissection because of nodal recurrence. Disease-free survival rates were significantly different between Groups I and II (P<0.05). Of note, the recurrence rate of Group II was still significantly higher than that of Group III (5.2% vs 0%, respectively; P=0.021). In addition, Kaplan-Mayer survival analysis indicated poor disease-free survival rates in Group II compared with Group III (P<0.05). Conclusion: The long-term treatment outcome of PTMC without LNM was favorable even if the recurrence occurs during follow-up period compared with that of PTMC with LNM. It should be noted that AS might be able to cause poor prognosis due to clinically apparent LNM.
Files in This Item:
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DOI
10.2147/CMAR.S173853
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Sang Wook(강상욱) ORCID logo https://orcid.org/0000-0001-5355-833X
Nam, Kee Hyun(남기현) ORCID logo https://orcid.org/0000-0002-6852-1190
Lee, Seul Gi(이슬기) ORCID logo https://orcid.org/0000-0003-3233-7823
Lee, Woo Kyung(이우경) ORCID logo https://orcid.org/0000-0002-6737-3173
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Lee, Jan Dee(이잔디) ORCID logo https://orcid.org/0000-0003-4090-0049
Lee, Cho Rok(이초록) ORCID logo https://orcid.org/0000-0001-7848-3709
Chung, Woung Youn(정웅윤)
Jeong, Jong Ju(정종주) ORCID logo https://orcid.org/0000-0002-4155-6035
Jo, Young Suk(조영석) ORCID logo https://orcid.org/0000-0001-9926-8389
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163493
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