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Zuhur SS, Aggul H, Avci U, Erol S, Tuna MM, Uysal S, Akbaba G, Kilinc F, Catak M, Tekin S, Ozturk BO, Yavuz HC, Kadioglu P, Cinar N, Bayraktaroglu T, Topcu B, Altuntas Y, Elbuken G. The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study. Endocrine 2024; 83:700-707. [PMID: 37736822 DOI: 10.1007/s12020-023-03533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC. METHODS The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox's proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method. RESULTS This study included 1013 patients (84% females), with a mean follow-up period of 62.5 ± 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02-5.81, p = 0.043; HR: 4.38, 95% CI: 1.7-11.2, p = 0.002, respectively). CONCLUSIONS In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.
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Affiliation(s)
- Sayid Shafi Zuhur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Hunkar Aggul
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Ugur Avci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selvinaz Erol
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Uysal
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Beyza Olcay Ozturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Halise Cinar Yavuz
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Birol Topcu
- Department of Biostatistics, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
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Jiang KC, Zhou DH, Luo DC. Microscopic extrathyroidal extension does not affect the prognosis of patients with papillary thyroid carcinoma: A propensity score matching analysis. Heliyon 2024; 10:e25280. [PMID: 38322895 PMCID: PMC10844248 DOI: 10.1016/j.heliyon.2024.e25280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
Background Extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) can be divided into two categories based on different degrees of invasion: microscopic ETE (micro-ETE) and macroscopic ETE (macro-ETE). At present, there is a consensus that macro-ETE significantly affects PTC prognosis, while the prognostic significance of micro-ETE remains controversial. Methods The clinicopathological and follow-up data for PTC patients who underwent surgical treatment at the Hangzhou First People's Hospital between 2015 and 2018 were retrospectively analyzed. According to the degree of ETE, patients were divided into three groups: non-ETE, micro-ETE and macro-ETE. Cox regression analysis was performed to evaluate the effect of ETE on recurrence-free survival (RFS). The propensity score matching (PSM) method was used to reduce the interference of confounding factors, and Kaplan-Meier curves were utilized to compare the RFS. Results Both micro- and macro-ETE were associated with some aggressive tumor features, including tumor size, multifocality, and lymph node metastasis. Univariate and multivariate Cox regression analyses showed that macro-ETE was an independent risk factor for recurrence, while micro-ETE was not associated with recurrence. The K-M curves showed that RFS for micro-ETE and non-ETE were not statistically different before and after PSM, while RFS for macro-ETE was significantly shorter than that for non-ETE. Conclusion The presence of micro-ETE in PTC did not affect prognosis of patients, suggesting that its treatment should be consistent with the treatment for intrathyroidal tumors. The surgical method and the necessity for radioiodine therapy should be carefully evaluated to reduce overtreatment.
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Affiliation(s)
- Ke-cheng Jiang
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-hui Zhou
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ding-cun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, China
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Patti L, Gay S, Musso L, Maltese C, Spina B, Minuto M, Morbelli S, Vera L, Boschetti M, Ferone D, Albertelli M. Impact of microscopic extrathyroidal extension on differentiated thyroid cancer post-surgical risk of recurrence: a retrospective analysis. J Endocrinol Invest 2023; 46:2157-2164. [PMID: 36976482 PMCID: PMC10514175 DOI: 10.1007/s40618-023-02070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE In the last edition of the American Joint Committee on Cancer (AJCC) staging system, differentiated thyroid cancers (DTC) showing microscopic extrathyroidal extension (mETE) are considered comparable to intrathyroidal cancers for their clinical behavior and prognosis. The aim of the study is to evaluate the impact of this updated assessment of T, when applied to the postoperative recurrence risk stratification, according to the American Thyroid Association Guidelines (ATA-RR). METHODS One-hundred DTC patients who underwent total thyroidectomy were retrospectively evaluated. The downstaging of mETE was introduced in the definition of T, and the updated classification defined as modified ATA-RR (ATAm-RR). For each patient, post-surgical basal and stimulated thyroglobulin (Tg) levels, neck ultrasound (US) and post-ablative 131-I whole body scan (WBS) reports were considered. The predictive performance (PP) of disease recurrence was calculated both for each single parameter, as well as for all of them. RESULTS According to ATAm-RR classification, 19/100 patients (19%) were downstaged. ATA-RR proved a significant PP for disease recurrence (DR) (sensitivity 75.0%, specificity 63.0%, p = 0.023). However, ATAm-RR performed slightly better due to an increased specificity (sensitivity 75.0%, specificity 83.7%, p < 0.001). For both classifications, the PP was optimal when all the above-mentioned predictive parameters were considered. CONCLUSION Our results suggest that the new assessment of T considering mETE resulted in a downgrading of ATA-RR class in a significant number of patients. This provides a better PP for disease recurrence, and the best PP was obtained when considering the whole predictive variables together.
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Affiliation(s)
- L Patti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - S Gay
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy.
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - L Musso
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - C Maltese
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - B Spina
- Hospital Anatomic Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Minuto
- Endocrine Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - S Morbelli
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - L Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
| | - D Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy
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