Minimal Extrathyroid Extension Does Not Affect the Relapse-Free Survival of Patients with Papillary Thyroid Carcinoma Measuring 4 cm or Less over the Age of 45 Years

Ito, Yasuhiro; Tomoda, Chisato; Uruno, Takashi; Takamura, Yuuki; Miya, Akihiro; Kobayashi, Kaoru; Matsuzuka, Fumio; Kuma, Kanji; Miyauchi, Akira

doi:10.1007/s00595-005-3090-8

Cited by 87 publications

(67 citation statements)

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“…In this series, Grade 1 patients had significantly worse DFS than Grade 0 patients and Grade 1 independently affected DFS on multivariate analysis, which was somewhat discrepant with our previous findings [5,9,10]. This is possibly because the patient series analyzed in this study is larger and average follow-up period is longer than those in the previous studies.…”

Section: Relationship Of Extension Grades To Patient Prognosiscontrasting

confidence: 99%

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

et al. 2011

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PaPillary thyroid carcinoma (PTC) is the most common malignancy arising from follicular cells of the thyroid. Generally, it is an indolent disease, but cases demonstrating certain characteristics are likely to show recurrence and even become life-threatening. Carcinoma extension is an important prognostic factor of PTC patients, which is adopted in various classification systems such as AMES [1], MACIS [2] and CIH classification [3]. However, all these systems evaluate carcinoma extension based only on its existence but not on its degree, indicating that cases showing a wide range of biological behaviors are classified into the same category.In the UICC TNM classification system [4], in contrast, there are three grades of extrathyroid extension; extension to sternothyroid muscle or perithyroid soft abstract. Carcinoma extension to adjacent organs is an important prognostic factor in papillary thyroid carcinoma (PTC). However, the biological behavior of PTC with carcinoma extension varies according to the degree of extension. In this study, we investigated whether and how subdivision of PTC extension accurately reflects patients' prognosis, using a series of 5508 patients with PTC without distant metastasis at presentation, who underwent initial surgery between 1988 and 2004. We classified extension from primary lesions or metastatic nodes into 4 grades based on intraoperative findings (Grade 0-4, Grades 3 and 4 were subdivision of T4a). Prognostic significance for disease-free and cause-specific survivals (DFS and CSS) of extension from primary lesions did not differ from that of extension from metastatic nodes in the same grades except for DFS of Grade 3 patients. DFS of patients became worse with higher grades and CSS was also significantly linked to advanced grades except for Grade 1. On multivariate analysis, Grades 1, 2 and 3 and Grades 2 and 3 were independent prognostic factors for DFS and CSS, respectively, together with other conventional prognostic factors. Taken together, extension from metastatic nodes has a prognostic significance equivalent to that from primary lesions if classified in the same grades. Subdivision of PTC extension corresponding to T4a into two grades can accurately reflect the biological behavior of PTC.

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Section: Relationship Of Extension Grades To Patient Prognosiscontrasting

confidence: 99%

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

et al. 2011

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“…Some investigators advocate EXT in tumors with extracapsular extension (Philips et al 1993) (T4 in AJCC 5th edition) and LN metastasis . The differentiation of extrathyroidal extension into minimal (T3b) and extensive involvement (T4) carries a prognostic implication (Ito et al 2006). We found that in patients with T3b category with negative or close margins, RAI gave a good rate of local control.…”

Section: Indications Of Ext In Ptcmentioning

confidence: 75%

Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition

Chow

Yau²,

Kwan

et al. 2006

Endocr Relat Cancer

129

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To identify indications for external radiotherapy (EXT) and radioactive iodine (RAI) in papillary thyroid carcinoma (PTC), we conducted a retrospective study of local and regional control in 1297 patients diagnosed with PTC in a tertiary referral center. Managed by surgery alone, patients with bilateral thyroidectomy had a lower rate of local relapse compared with lobectomy (PZ0.02). EXT improved locoregional (LR) failure-free survival (FFS) (P!0.001) and survival (PZ0.01) in patients with gross postoperative LR residual disease. EXT also improved local FFS in patients with pathologically confirmed positive resection margins (P!0.001) and reduced local failures in patients with T4 disease (PZ0.002). In patients with lymph nodes (LN) metastasis, more extensive surgery by functional or radical neck dissection resulted in less LN relapse compared with excision alone (P!0.001). EXT improved 10-year LN FFS in patients with N1b disease (PZ0.005) and patients with LN metastasis of size O2 cm (PZ0.02). RAI was effective in improving local control in patients with T2 to T4 diseases and LN control in patients with N0, N1a, and N1b categories. Local or LN relapses were associated with worse survival (P!0.001 and P!0.0001). The survival of patients with PTC could be improved by reducing local or LN relapses. RAI is indicated in patients with T2 to T4 disease. EXT is indicated in patients with gross postoperative disease, positive resection margins or T4 disease, N1b, or a LN size of O2 cm. LN relapse can be reduced by RAI in N0, N1a, and N1b disease.

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“…Among them, extrathyroid extension is prominent. Several studies demonstrated that PTC patients with extrathyroid extension show a significantly poorer prognosis than those without extrathyroid extension, and they were therefore classified as being at high risk [1][2][3][4][5].The recurrent laryngeal nerve (RN) is one of the most common organs to which PTC extends. The RN can be preserved when carcinoma extension is partial and the preoperative vocal cord function is normal [6].…”

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Prognosis and prognostic factors of patients with papillary thyroid carcinoma requiring resection of recurrent laryngeal nerve due to carcinoma extension

et al. 2012

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PaPillary thyroid carcinoma (Ptc) is the most common thyroid malignancy. Although it is generally indolent, several clinicopathological factors predicting a poorer prognosis in PTC patients have been identified. Among them, extrathyroid extension is prominent. Several studies demonstrated that PTC patients with extrathyroid extension show a significantly poorer prognosis than those without extrathyroid extension, and they were therefore classified as being at high risk [1][2][3][4][5].The recurrent laryngeal nerve (RN) is one of the most common organs to which PTC extends. The RN can be preserved when carcinoma extension is partial and the preoperative vocal cord function is normal [6]. However, RN resection is required when it is completely involved with the carcinoma and/or vocal cord paralysis is preoperatively detected. When the RN is resected, permanent vocal cord paralysis causing Prognosis and prognostic factors of patients with papillary thyroid carcinoma requiring resection of recurrent laryngeal nerve due to carcinoma extension Yasuhiro Ito, Minoru Kihara, Yuuki Takamura, Kaoru Kobayashi, Akihiro Miya and Akira Miyauchi Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan abstract. The recurrent laryngeal nerve (RN) is one of the most common organs to which papillary thyroid carcinoma (PTC) extends. However, the prognosis and prognostic factors for patients with PTC extending to the RN remain unclear. In this study, we investigated this issue in 298 patients who underwent initial and locally curative surgery for PTC requiring RN resection due to carcinoma extension. Preoperative vocal cord paralysis was detected in 179 patients (60.1%), and directly linked to significant extension to other organs, large tumor size, and advanced age. However, it did not have a significant prognostic impact on uni-or multivariate analyses. On multivariate analysis, independent prognostic factors were large node metastasis and advanced age for lymph node recurrence, significant extension to other organs for distant recurrence, and significant extension to other organs, large node metastasis, extranodal tumor extension, and advanced age for carcinoma death, respectively. Most prognostic factors identified in the entire series of patients also had a strong prognostic impact on the subset of patients requiring RN resection, together with significant extension to other organs. Preoperative vocal cord paralysis reflected the aggressive characteristic of PTC to some extent, but did not have a significant prognostic value.Key words: Papillary thyroid carcinoma, Prognosis, Recurrent laryngeal nerve hoarseness and aspiration occurs, but recovery in phonation is expected if nerve reconstruction is performed by end-to-end anastomosis with other nerves such as the ansa cervicalis [7][8][9].We previously showed that PTC extending only to the RN showed a better prognosis than that extending to other posterior organs such as the trachea and esophagus [1]. Furthermore, more recently, we proposed that T4a in the UICC TNM classificat...

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Minimal Extrathyroid Extension Does Not Affect the Relapse-Free Survival of Patients with Papillary Thyroid Carcinoma Measuring 4 cm or Less over the Age of 45 Years

Abstract: These findings suggest that tumors with minimal extension should be classified to have the same T grade as those without such extension, and upstaging of such tumors is therefore not appropriate.

Cited by 87 publications

References 6 publications

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition

Prognosis and prognostic factors of patients with papillary thyroid carcinoma requiring resection of recurrent laryngeal nerve due to carcinoma extension

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