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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

 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 
 Cancer Management and Research, Vol.10 : 2883-2891, 2018 
Journal Title
 Cancer Management and Research 
Issue Date
active surveillance ; lymphatic metastasis ; neoplasm recurrence ; papillary thyroid microcarcinoma
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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
강상욱(Kang, Sang Wook) ORCID logo https://orcid.org/0000-0001-5355-833X
남기현(Nam, Kee Hyun) ORCID logo https://orcid.org/0000-0002-6852-1190
이슬기(Lee, Seul Gi) ORCID logo https://orcid.org/0000-0003-3233-7823
이우경(Lee, Woo Kyung) ORCID logo https://orcid.org/0000-0002-6737-3173
이은직(Lee, Eun Jig) ORCID logo https://orcid.org/0000-0002-9876-8370
이잔디(Lee, Jan Dee) ORCID logo https://orcid.org/0000-0003-4090-0049
이초록(Lee, Cho Rok)
정웅윤(Chung, Woung Youn)
정종주(Jeong, Jong Ju) ORCID logo https://orcid.org/0000-0002-4155-6035
조영석(Jo, Young Suk) ORCID logo https://orcid.org/0000-0001-9926-8389
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