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World Journal of Surgery

, Volume 30, Issue 5, pp 780–786 | Cite as

Prognostic Significance of Extrathyroid Extension of Papillary Thyroid Carcinoma: Massive but Not Minimal Extension Affects the Relapse-free Survival

  • Yasuhiro ItoEmail author
  • Chisato Tomoda
  • Takashi Uruno
  • Yuuki Takamura
  • Akihiro Miya
  • Kaoru Kobayashi
  • Fumio Matsuzuka
  • Kanji Kuma
  • Akira Miyauchi
Article

Abstract

Objectives

Extrathyroid extension has been recognized as a prognostic factor in papillary thyroid carcinoma. In the most recent version of the UICC TNM classification system, extrathyroid extension has been classified into two grades, minimal extension (extension to sternothyroid muscle or perithyroid soft tissues) and massive extension (extension to subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve). In this study, we investigated the prognostic significance of each of the two types of extension.

Patients and Methods

One thousand and sixty-seven patients with papillary thyroid carcinoma without distant metastasis at surgery, who underwent surgical treatment in Kuma hospital between 1990 and 1995 and had been followed postoperatively for 60 months or more, were enrolled in this study. The grading of extrathyroid extension was based on both pathological findings and intraoperative surgical findings.

Results

In univariate analysis, although patients with massive extension showed a significantly worse relapse-free survival (RFS) rate than those with no or minimal extension (P < 0.0001), there was no difference in the RFS rate between patients with no extension and those with minimal extension. Among patients with massive extension, the RFS rate tended to be worse in those with posterior extension than in those with anterior extension (P = 0.0562). Furthermore, the RFS rate of patients with massive posterior extension only to the recurrent nerve demonstrated a better RFS rate than those with extension to other posterior organs (P = 0.0052). Multivariate analysis demonstrated that massive extrathyroid extension is recognized as an independent prognostic factor for RFS (P = 0.0003).

Conclusions

These findings suggest that (1) upgrading of T category for tumors with massive extension is appropriate, whereas that for tumors with only minimal extension is not, and (2) careful surgical treatment and postoperative follow-up are required for tumors with massive extension to posterior organs other than the recurrent laryngeal nerve.

Keywords

Papillary Thyroid Carcinoma Recurrent Laryngeal Nerve Extrathyroid Extension Minimal Extension Posterior Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • Yasuhiro Ito
    • 1
    Email author
  • Chisato Tomoda
    • 1
  • Takashi Uruno
    • 1
  • Yuuki Takamura
    • 1
  • Akihiro Miya
    • 1
  • Kaoru Kobayashi
    • 1
  • Fumio Matsuzuka
    • 1
  • Kanji Kuma
    • 1
  • Akira Miyauchi
    • 1
  1. 1.Department of SurgeryKuma HospitalKobe CityJapan

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