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Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy.

Authors
 Jung Bum Choi  ;  Seul Gi Lee  ;  Min Jhi Kim  ;  Tae Hyung Kim  ;  Eun Jeong Ban  ;  Cho Rok Lee  ;  Jandee Lee  ;  Sang‐Wook Kang  ;  Jong Ju Jeong  ;  Kee‐Hyun Nam  ;  Woong Youn Chung  ;  Cheong Soo Park 
Citation
 Head & Neck, Vol.41(1) : 56-63, 2019 
Journal Title
 Head & Neck 
ISSN
 1043-3074 
Issue Date
2019
Keywords
differentiated thyroid carcinoma ; oncologic outcome ; prognosis ; thyroid cancer ; thyroidectomy extent
Abstract
BACKGROUND: Recent guidelines advocate unilateral thyroidectomy for low-risk 1-cm to 4-cm differentiated thyroid cancer (DTC). This study was designed to examine the association between the extent of thyroidectomy and oncologic outcomes in patients with 1-cm to 4-cm DTC. MATERIALS AND METHODS: From April 1978 to December 2011, 16 057 patients with DTC underwent thyroidectomy at Yonsei University Hospital. Among them, 5266 (32.8%) patients were classified as having 1-cm to 4-cm DTC and were enrolled in this study. Clinicopathologic features and prognostic results (disease-free survival [DFS] and disease-specific survival [DSS] rates) were analyzed by retrospective medical record review. The mean follow-up duration was 57.3 ± 58.1 months. RESULTS: Of tumor subtypes in the study group, papillary thyroid carcinoma was the most common (97.5%) and follicular thyroid carcinoma occurred at a rate of 2.5%. In this study, the mean tumor size was 1.84 ± 0.74 cm. Patients had extrathyroidal extension (69.3%), multiplicity (35.1%), bilaterality (26.4%), central lymph node metastasis (53.0%), and lateral neck node metastases (19.9%). Of the 5266 patients, 4292 (81.5%) underwent total thyroidectomy and 974 (18.5%) had lobectomies. Recurrence rates in the total thyroidectomy and lobectomy groups were 5.7% and 9.4%, respectively. The lobectomy group had lower DFS (P = .007) and higher DSS (P = .034) than the total thyroidectomy group. A multivariate analysis for DFS revealed that tumor size, N classification, and extent of thyroidectomy were independent risk factors. On multivariate analysis, independent risk factors for DSS were age, sex, tumor size, and M classifications. CONCLUSION: Although extent of thyroidectomy does not affect DSS, total thyroidectomy is beneficial for reducing recurrence in patients with 1-cm to 4-cm DTC. However, if such tumors have such low-risk features as being unifocal, intrathyroidal, and lymph node metastasis-negative, extent of thyroidectomy does not affect oncologic outcome and lobectomy may be sufficient.
Full Text
https://onlinelibrary.wiley.com/doi/full/10.1002/hed.25356
DOI
10.1002/hed.25356
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
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
박정수(Park, Cheong Soo)
이잔디(Lee, Jan Dee) ORCID logo https://orcid.org/0000-0003-4090-0049
이초록(Lee, Cho Rok) ORCID logo https://orcid.org/0000-0001-7848-3709
정웅윤(Chung, Woung Youn)
정종주(Jeong, Jong Ju) ORCID logo https://orcid.org/0000-0002-4155-6035
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167429
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