A Relook at the T Stage of Differentiated Thyroid Carcinoma with a Focus on Gross Extrathyroidal Extension

Song, Eyun; Lee, Yu‐Mi; Oh, Hye-Seon; Jeon, Min Ji; Song, Dong Eun; Kim, Tae Yong; Kim, Won; Shong, Young Kee; Sung, Tae‐Yon

doi:10.1089/thy.2018.0300

Cited by 35 publications

(50 citation statements)

References 16 publications

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“…According to the eighth edition of the AJCC cancer staging system, gETE significantly affects the prognosis of patients, while mETE no longer applies to tumor staging for PTC. 14,18,19 In the present study, 907 (24.6%) patients exhibited ETE, and ETE was identified as an independent risk factor for cervical LNM.…”

Section: Discussionsupporting

confidence: 53%

“…ETE is stratified into minimal ETE (mETE), identified by histopathological examinations, and gross ETE (gETE), detected by intraoperative findings. 14,18 The reported incidence rate of ETE ranges from 5% to 55% in PTMC, which is associated with LNM and disease recurrence. According to the eighth edition of the AJCC cancer staging system, gETE significantly affects the prognosis of patients, while mETE no longer applies to tumor staging for PTC.…”

Section: Discussionmentioning

confidence: 99%

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<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Song¹,

Yan²,

Qiu³

et al. 2020

CMAR

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To investigate the risk factors for cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Patients and Methods: In total, 3686 patients with PTMC who underwent initial surgery in Shanghai Jiao Tong University affiliated Sixth People's Hospital from January 2010 to December 2019 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify risk factors associated with cervical LNM.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Song¹,

Yan²,

Qiu³

et al. 2020

CMAR

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“…The newly introduced staging factor of gross strap muscle invasion alone (T3b) has been associated with higher risk of positive resection margin, bigger tumor size, higher recurrence rate, and lower disease survival rate 8 – 10 . However, studies have reported that strap muscle invasion alone, both minimal and gross, may not have significant influence on overall survival 11 , 12 , particularly in tumors equal to or smaller than 40 mm 13 . A recent study has also suggested similar disease-free survival rate between the minimal ETE and gross strap muscle invasion alone groups in papillary thyroid carcinomas with tumor size 10- to 40-mm 14 .…”

Section: Introductionmentioning

confidence: 98%

Strap muscle invasion in differentiated thyroid cancer does not impact disease-specific survival: a population-based study

Yoon

Lee

Kim

et al. 2020

Sci Rep

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The American Joint Committee on Cancer (AJCC) 8th TNM staging system of differentiated thyroid cancer defines gross strap muscle invasion as T3b stage. However, the impact of strap muscle invasion on disease-specific survival (DSS) remains controversial. To elucidate the survival impact of strap muscle invasion of any degree in thyroid cancers, the Surveillance, Epidemiology, and End Results (SEER) database (1973–2018) was queried for thyroid cancer only patients on July 2019 (n = 19,914). The Cox proportional hazard analysis with multivariable adjustment revealed that strap muscle invasion was not a significant factor for DSS in tumors equal to or smaller than 40 mm (hazard ratio (HR) = 1.620 [confidence interval (CI) 0.917 – 2.860]; p = 0.097). The competing risk analysis with multivariable adjustment showed that strap muscle invasion did not significantly impact DSS regardless of tumor size or cause of death (cancer-caused death (Subdistribution HR (SDHR) = 1.567 [CI 0.984 – 2.495]; p = 0.059); deaths to other causes (SDHR = 1.155 [CI 0.842 – 1.585]; p = 0.370). A “modified” staging schema discarding strap muscle invasion as a T stage criterion showed better 10-year DSS distinction between T stages. The modified staging schema may better reflect cancer-caused death risk and may prevent potential overstaging.

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“…This may limit the broad generalizations of the study as lobectomy is recommended in patient with cN0 disease and without ETE. However, the clinical significance of cN1a disease and gross ETE invading only the strap muscle is not clear in patients undergoing lobectomy . Despite the small number of patients, cN1a disease and gross ETE did not increase the risk for recurrence following lobectomy; further studies are necessary to validate their significance.…”

Section: Discussionmentioning

confidence: 93%

Modified risk stratification based on cervical lymph node metastases following lobectomy for papillary thyroid carcinoma

Song

Ahn

Song

et al. 2019

Clinical Endocrinology

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Objective Evidence for American Thyroid Association (ATA) risk stratification stems largely from studies involving patients undergoing total thyroidectomy. We aimed to assess the risk of recurrence according to the present ATA risk stratification system in patients who underwent lobectomy. Design Retrospective cohort study. Patients Patients who underwent thyroid lobectomy for 1‐4 cm‐sized papillary thyroid carcinoma (n = 571). Measurements Disease‐free survival (DFS) was compared according to the ATA risk stratification, and specific lymph node (LN) characteristics were evaluated to modify the ATA criteria with a higher predictability for recurrence. Results Based on the ATA risk stratification, 439 patients (61.1%) were classified into intermediate‐ or high‐risk group, and consideration for completion thyroidectomy is suggested by ATA guidelines for these patients. However, no significant differences were found in DFS among the low‐, intermediate‐ and high‐risk groups (P = .9). In contrast, when patients were stratified according solely to the LN criteria from the ATA risk stratification, only 127 patients (22.2%) had intermediate risk (intermediate‐N1a) and exhibited significantly poorer DFS than those with N0 disease (P = .035). Modifying the intermediate‐N1a criteria by adding the extranodal extension (ENE) status and omitting the clinical nodal disease enabled the subclassification of 19 patients (3%) with a high risk for recurrence. Conclusions The present study suggests that risk stratification based solely on LN metastases is more reasonable for predicting structural persistence/recurrence following lobectomy than that based on the overall ATA criteria. Considering the ENE status can assist in selecting patients with a high risk of recurrence to minimize further treatments.

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A Relook at the T Stage of Differentiated Thyroid Carcinoma with a Focus on Gross Extrathyroidal Extension

Cited by 35 publications

References 16 publications

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Strap muscle invasion in differentiated thyroid cancer does not impact disease-specific survival: a population-based study

Modified risk stratification based on cervical lymph node metastases following lobectomy for papillary thyroid carcinoma

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