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. 2023 Sep 18;23(1):880.
doi: 10.1186/s12885-023-11307-1.

Association between surgical extent and recurrence in unilateral intermediate- to high-risk papillary thyroid cancer

Siyuan Xu #  1 , Hui Huang #  2 , Huilei Dong #  3 , Xiaolei Wang  2 , Zhengang Xu  2 , Shaoyan Liu  4 , Jie Liu  5
Affiliations

Association between surgical extent and recurrence in unilateral intermediate- to high-risk papillary thyroid cancer

Siyuan Xu et al. BMC Cancer. .

Abstract

Background: Guidelines recommend total thyroidectomy (TT) to facilitate radioactive ablation and serological follow-up for intermediate- to high-risk papillary thyroid carcinoma (PTC). However, the association between surgical extent and tumor recurrence in these patients has not been well validated. We aimed to examine the association between the extent of surgery and recurrence in patients with completely resected unilateral intermediate- to high-risk PTC.

Methods: Patients with completely resected unilateral PTC from 2000 to 2017 in a single institute were reviewed. Those who had extrathyroidal extension (ETE) or lymph node metastasis (LNM, cN1 or pN1 > 5 lymph nodes involved) were included for analysis. Cox proportional hazards models were applied to measure the association between surgical extent and recurrence-free survival (RFS) while adjusting for patient demographic, clinicopathological and treatment variables.

Results: A total of 4550 patients (mean[SD] age, 43.0[11.7] years; 3379 women[74.3%]) were included. Of these patients, 2262(49.7%), 656(14.4%), 1032(22.7%), and 600 (13.2%) underwent lobectomy, TT, lobectomy + neck dissection (ND) and TT + ND, respectively. With a median follow-up period of 68 months, after multivariate adjustment, lobectomy was associated with a compromised RFS compared with other surgical extents (HR[95%CI], TT 0.537[0.333-0.866], P = 0.011, lobectomy + ND 0.531[0.392-0.720] P < 0.0001, TT + ND 0.446[0.286-0.697] P < 0.0001). RFS was similar between the two extents with ND (lobectomy + ND, HR [95%CI], 1.196 [0.759-1.885], P = 0.440).

Conclusion: Lobectomy alone is associated with an elevated recurrence risk in patients with unilateral intermediate- to high-risk PTC compared with larger surgical extents. However, lobectomy and ND may provide similar tumor control compared with the conventional approach of TT and ND.

Keywords: Lobectomy; total thyroidectomy; Papillary thyroid carcinoma; Recurrence-free survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Unadjusted RFS of patients who underwent lobectomy or TT (1a), P = 0.017. Unadjusted RFS of patients who underwent lobectomy + ND or TT + ND (1b), P = 0.750
Fig. 2
Fig. 2
Unadjusted RFS of patients with or without gETE, P < 0.0001
Fig. 3
Fig. 3
Adjusted RFS of patients with different surgical extents (adjusting sex, patient age, primary size, ETE, g ETE, multifocality, LNM, ENE, central neck dissection and RAI), P < 0.0001
Fig. 4
Fig. 4
Adjusted RFS of patients who underwent lobectomy + ND or TT + ND (adjusted for sex, patient age, primary size, ETE, gETE, multifocality, LNM, ENE and RAI), P = 0.440
See this image and copyright information in PMC

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