Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

Abraham, Earl; Tran, Bryan; Roshan, David; Graham, Susannah; Lehane, Christopher; Wykes, James; Campbell, Peter; Ebrahimi, Ardalan

doi:10.1111/ans.14490

Cited by 7 publications

(5 citation statements)

References 13 publications

(31 reference statements)

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“…They note significant differences in baseline characteristics between patients with clear margins and those with microscopic positive margins. 1 The strong association of positive margins with other adverse features is not unexpected and consistent with the literature. 2 We performed a multivariate analysis to elucidate the independent impact of microscopic positive margins whilst adjusting for these potential confounding factors and found no independent association with disease recurrence.…”

supporting

confidence: 86%

“…We read with interest the article by Abraham et al 1 Enrolling 610 patients undergoing surgery for papillary thyroid carcinoma (PTC) from 1987 to 2016 at Liverpool Hospital, this retrospective study investigated the association between microscopic positive margins in PTC and disease recurrence, and concluded that microscopic positive margins in PTC do not impact disease recurrence. Herein, we would like to raise the following comments.…”

mentioning

confidence: 99%

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Re: Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

Yang

2018

ANZ Journal of Surgery

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supporting

confidence: 86%

mentioning

confidence: 99%

Re: Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

Yang

2018

ANZ Journal of Surgery

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“…Therefore, comprehensive consideration could be taken according to individual differences and tumor characteristics to ensure the integrity of tumor resection and individualized treatment. 30 …”

Section: Discussionmentioning

confidence: 99%

“Micro” Extrathyroidal Extension in Risk Stratification for Papillary Thyroid Carcinoma: Should It Be in the Intermediate-Risk or High-Risk Group? A Single-Center Retrospective Study

He¹,

Ji²,

Fu³

et al. 2022

CMAR

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Introduction Currently, there is no consensus on the specific effect of Extrathyroidal Extension (ETE) on prognosis. The purpose of our study was to study the relationship between different states of ETE and its disease-free survival rate and to determine the basic standard of Micro ETE (tumor extends through capsule only) in risk stratification. Material and Methods We conducted a retrospective and single-center study that included the clinical data of all papillary thyroid carcinoma (PTC) patients with ETE in our hospital from 2013 to 2017 and followed them up after rigorous screening. According to ETE state, it is divided into four groups: Microscopic, Micro, Minimal, Macro. Kaplan–Meier method was used to calculate disease-free survival (DFS). Log-rank test was used to compare the differences between the groups and to polt the survival curves. P<0.05 was considered statistically significant. Micro ETE was included in different risk stratification subgroups and their DFS was compared. Results A total of 436 patients were included: Microscopic group N=50 (11.47%), Micro group N=74 (16.97%), Minimal group N=135 (30.96%), and Macro group N=177 (40.60%). The frequency of ETE was in strap muscles N=191, trachea N=114, laryngeal recurrent nerve N=92, and capsule N=74, etc. The 5-year DFS rate in Micro group was 95.3%, higher than that in Macro group (P<0.05). The 5-year DFS rate of Micro ETE was 90.0% in the intermediate-risk group and 84.9% in the high-risk group when Micro ETE was included in different risk stratification subgroups. Conclusion Micro ETE deserves more attention, has a batter prognosis than Macro ETE, and may have little effect on recurrence. It seems more appropriate to treat Micro ETE as the intermediate-risk group in risk stratification.

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“…Several studies on microscopic positive tumour margins have reported that there is no association with recurrence. [14][15][16] Recently, Abraham et al 17,18 reported that microscopic positive tumour margins did not affect disease-free survival in the majority of patients with PTC, but was associated with a four-fold increased risk of recurrence in T4a patients. This supports the results of our study, which was conducted among T4a patients with RLN involvement.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of T4a Papillary Thyroid Cancer With Recurrent Laryngeal Nerve Involvement: A Retrospective Analysis

Kwon

Shin

et al. 2020

Preprint

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Preoperative vocal cord palsy (VCP) may indicate locally invasive papillary thyroid cancer (PTC); using this relationship, we evaluated the clinical outcomes and risk factors for recurrence in post-thyroidectomy T4a PTC patients with recurrent laryngeal nerve (RLN) involvement. We retrospectively investigated thyroidectomy patients, recorded their clinical factors, recurrence rate, and pathological findings, and analysed the relationship between recurrence rate and clinical factors. Of 72 patients, 37 (51%) had preoperative VCP and 35 (49%) had normal preoperative vocal cord movement with confirmed intraoperative RLN invasion. Tracheal and esophageal invasion was observed in 13 (18%) and 15 (21%) patients, respectively. Thyroid cancer recurred in 18 (25%) patients over 58 months, resulting in 2 (3%) deaths. Recurrence was not associated with surgical extent, organ invasion, enlarged tumour size, or lymph node infiltration (p > 0.05). The recurrence rate was significantly higher in patients with positive resection margins (p < 0.05). T4a PTC patients with RLN involvement showed a poor prognosis. The recurrence rate was not affected by preoperative VCP, intraoperative detection of RLN invasion, nerve resection, nerve preservation by shaving, lymph node metastasis, or tracheal or esophageal invasion. The most important prognostic factor for recurrence was a positive resection margin.

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Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

Abstract: Despite a strong association between microscopic positive margins and other adverse prognostic factors in PTC, there is no independent association with disease recurrence on multivariate analysis. Microscopic positive margins are rare (1.1%) in the absence of other indications for RAI.

Cited by 7 publications

References 13 publications

Re: Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

Re: Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

“Micro” Extrathyroidal Extension in Risk Stratification for Papillary Thyroid Carcinoma: Should It Be in the Intermediate-Risk or High-Risk Group? A Single-Center Retrospective Study

Clinical Outcomes of T4a Papillary Thyroid Cancer With Recurrent Laryngeal Nerve Involvement: A Retrospective Analysis

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