Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features

Abstract

Background Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features. Methods Consecutive patients with PTC and at least one high-risk feature treated in 2000–2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five5 central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis. Results Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case–control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784). Conclusion Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.

Prevalence of Hashimoto Thyroiditis in Adults With Papillary Thyroid Cancer and Its Association With Cancer Recurrence and Outcomes

“…First, in the study cohort, the proportion of patients who underwent lobectomy was greater than that in other studies, 7 and RAI ablation was performed less often in the study cohort, which could have affected the outcomes. According to findings from previous studies, 26,27 this conservative approach likely did not compromise long-term survival in the present study. Stratification analysis of both mortality and recurrence showed the protective effect of HT in the total thyroidectomy subgroup, and results were similar between patients who had and had not undergone RAI ablation.…”

Pattern and predictive factors of occult contralateral central lymph node metastases in unilateral papillary thyroid carcinoma with ipsilateral clinical lymph node metastasis

“…The goal of this approach is to minimize the risk of recurrence, lower mortality rates, and ameliorate the overall prognosis (6). However, recent studies showed that PTC patients with high-risk characteristics who underwent lobectomy and total thyroidectomy do not show any statistically signi cant difference in 10-year disease-speci c survival and disease-free survival (7,8). A study showed that nearly 70% of patients with unilateral PTC combined with ipsilateral cN1b do not have occult CLNM (5).…”

Long‐Term Outcomes After Lobectomy for Patients with High‐Risk Papillary Thyroid Carcinoma

“…The study cohort was from a tertiary oncology referral center, so the patients might have had much higher‐risk features, such as massive extrathyroidal invasion or large nodal metastasis, compared to other reports [12, 13]. Indeed, a total of 56 patients underwent extended radical surgery including full‐layer resection of the trachea/larynx and/or esophagus/pharynx or wide dissection to the mediastinum or retropharyngeal lymph nodes.…”

“…That is, patients can be directly treated using RAI, and recurrences are easily evaluated by thyroglobulin follow‐up. However, few reports have shown definite superiority of total thyroidectomy over lobectomy in terms of the survival of high‐risk PTC patients [12, 13]. The aim of the study was to clarify the long‐term treatment outcomes of curative surgery with lobectomy compared with total or near‐total thyroidectomy for patients with high‐risk PTC without distant metastasis at a Japanese tertiary oncology referral center.…”