Predictive Factors Indicative of Hemithyroidectomy and Close Follow-Up versus Bilateral Total Thyroidectomy for Aggressive Variants of Papillary Thyroid Cancer

Abstract

The diagnostic and treatment rates of early thyroid cancer have been increasing, including those of aggressive variants of papillary thyroid cancer (AVPTC). This study aimed to analyze the need for completion total thyroidectomy after lobectomy for clinically low-to-intermediate-risk AVPTC. Overall, 249 patients who underwent hemithyroidectomy (HT, n = 46) or bilateral total thyroidectomy (BTT, n = 203) for AVPTC between November 2005 and December 2019 at our single institution were examined. The average follow-up period was 14.9 years, with a recurrence rate of 4.3% and 10.8% in the HT and BTT groups, respectively. Multivariate Cox analysis revealed that palpable tumor on the neck during evaluation (HR, 2.7; 95% CI, 1.1-6.4; p = 0.025), clinical N1b (HR, 8.3; 95% CI, 1.1-63.4; p = 0.041), tumor size (cm) (HR, 1.3; 95% CI, 1.0-1.7; p = 0.036), gross extrathyroidal extension (HR, 3.1; 95% CI, 1.4-7.0; p = 0.007), and pathologic T3b (HR, 3.4; 95% CI, 1.0-11.4; p = 0.045) or T4a (HR, 6.0; 95% CI, 1.9-18.8; p = 0.002) were associated with an increased risk of recurrence. Incidentalomas identified during diagnosis had a significantly lower risk of recurrence (HR, 0.4; 95% CI, 0.2-0.9; p = 0.033). Close follow-up may be performed without completion total thyroidectomy for AVPTC found incidentally after HT.