Affiliation:
1. Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
2. Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
Abstract
Minimal extrathyroid extension (mETE) effect on papillary thyroid carcinoma (PC) prognosis is still debated even more so now that this factor has been removed in the 8th AJCC Edition, supporting the hypothesis that mETE is not associated with aggressive tumors. We retrospectively enrolled 91 PC patients (Group 1) submitted to total thyroidectomy and radioiodine ablation. At the time of the primary tumor surgery, mETE was ascertained in all patients with no other risk factors, such as multifocality, vascular invasion, neck and distant metastases, and aggressive histological variants. As controls, 205 consecutive matched PC patients (Group 2) without mETE and the aforementioned risk factors were enrolled. During the follow-up (average 8 years), 16/91 (17.58%) Group 1 patients and 15/205 (7.32%) Group 2 patients developed metastases (p = 0.0078). Cox regression analysis showed an increased risk of metastases in patients with mETE (HR: 2.58 (95% CI 1.28–5.22) p = 0.008). Disease-free survival (DFS) was significantly lower in patients with mETE than in controls (p = 0.0059). The present study seems to demonstrate that mETE can be associated with an aggressive PC and can be considered, even alone without other risk factors, an independent factor of unfavorable DFS. Thus, by excluding mETE in the 8th AJCC Edition, patient care and management could be compromised.
Subject
General Biochemistry, Genetics and Molecular Biology,Medicine (miscellaneous)
Reference53 articles.
1. An Expanded View of Risk-Group Definition in Differentiated Thyroid Carcinoma;Cady;Surgery,1988
2. Differentiated Carcinoma of the Thyroid with Extrathyroidal Extension;Andersen;Am. J. Surg.,1995
3. Extrathyroid Spread in Papillary Carcinoma of the Thyroid: Clinicopathological and Prognostic Study;Ortiz;Otolaryngol.-Head Neck Surg.,2001
4. Managing Patients with Papillary Thyroid Carcinoma: Insights Gained from the Mayo Clinic’s Experience of Treating 2512 Consecutive Patients during 1940 through 2000;Hay;Trans. Am. Clin. Climatol. Assoc.,2002
5. Papillary Thyroid Carcinoma;Hay;Am. J. Surg. Pathol.,2003