The optimal surgical approach for papillary thyroid carcinoma with pathological n1 metastases: An analysis from the SEER database

Abstract

Objectives/Hypothesis: The definition of large-volume pathologic N1 metastases has been changed in the 2017 version 2 of the National Comprehensive Cancer Network guidelines, leading to a controversy over the optimal surgical approach selection for patients with biopsy-proven papillary thyroid carcinoma (PTC). The aim of this study was to investigate the therapeutic efficacy of total thyroidectomy (TT) and thyroid lobectomy (TL) for these patients.Study Design: Retrospective population-based database analysis.Methods: A total of 906 consecutive PTC patients with pathologic N1 metastases (>5 involved nodes with metastases ≤5 mm in the largest dimension) were retrieved from the Surveillance, Epidemiology, and End Results database, and divided into two groups (≤2 mm, >2-5 mm) based on the size of the extent of disease. Overall survival (OS) was then compared between patients treated with TT and TL, followed by Cox proportional hazards regression analysis to explore multiple prognostic factors.Results: OS favored TT compared with TL in patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension (P < .05). Cox analysis showed that the TL was not an independent factor associated with poorer OS than TT in these patients (P > .05).Conclusions: TT showed better survival than TL for patients with more than five involved nodes and metastases >2 to 5 mm in the largest dimension. For patients with more than five involved nodes and metastases ≤2 mm in the largest dimension, either TT or TL can be recommended because there was no difference in survival.

How good is lobectomy for the Turkish population with papillary thyroid cancer? A clinicopathological evaluation

“…al., it has been reported that tumor size, except for angioinvasion, was not a significant predictor for the presence of postoperative risk factors (20). In another study evaluating 906 patients with PTC and pathologic N1 metastasis, it has been reported that total thyroidectomy was associated with better survival outcomes compared to lobectomy in patients with more than five lymph node metastases and metastatic lymph node sizes between 2-5 mm (29). In a Korean study analyzing data from 3282 patients with tumor sizes below 2 cm, it has been found that patients who underwent lobectomy had higher rates of long-term recurrence in cases where the tumor size was larger than 18 mm, there were two or more lymph node metastases, or bilateral tumors were present.…”