Advertisement

World Journal of Surgery

, Volume 36, Issue 6, pp 1274–1278 | Cite as

Prognostic Factors for Recurrence of Papillary Thyroid Carcinoma in the Lymph Nodes, Lung, and Bone: Analysis of 5,768 Patients with Average 10-year Follow-up

  • Yasuhiro ItoEmail author
  • Takumi Kudo
  • Kaoru Kobayashi
  • Akihiro Miya
  • Kiyoshi Ichihara
  • Akira Miyauchi
Article

Abstract

Background

Papillary thyroid carcinoma (PTC) frequently recurs to the lymph nodes, which may not be fatal immediately but is a stressor for physicians and patients. Recurrence to the distant organs, although less frequent, is often life-threatening, and the lung and bone are organs to which PTC is likely to recur. In the present study we investigated factors predicting recurrence of PTC to the lymph nodes, lung, and bone in a large number of patients undergoing long-term follow-up.

Methods

A total of 5,768 PTC patients (608 males and 5,159 females) without distant metastasis at diagnosis who underwent initial surgery between 1987 and 2004 in Kuma Hospital were enrolled in this study. The postoperative follow-up ranged from 12 to 280 months, and was 129 months (10.8 years) on average.

Results

To date, node, lung, and bone recurrences have been detected in 389 (7%), 118 (2%), and 33 patients (0.6%), respectively, and 57 patients (1%) have died of PTC. We examined the prognostic significance of the tumor size (T), extrathyroid extension (Ex), age 55 years or older (Age), male gender (Gender), clinical node metastasis (N), and extranodal tumor extension (LN-Ex) for each outcome on multivariate analysis. Age, Gender, T > 2 cm, N, and Ex were independent predictors of lymph node recurrence. Age, Ex, T > 2 cm, and N were independent prognostic factors for lung recurrence. Ex, T > 4 cm, and N independently predicted bone recurrence. Of these, N ≥ 3 cm had the strongest prognostic value for lymph node, lung, and bone recurrences. In contrast, Age was the strongest predictor for carcinoma death. LN-Ex also had a prognostic value for carcinoma death, although it was not a predictor of carcinoma recurrence. Ex, N ≥ 3 cm, and T > 2 cm also had a prognostic impact on carcinoma death.

Conclusions

Large lymph node metastasis showed a strong prognostic impact on carcinoma recurrence not only to the lymph nodes but also to the lung and bone, and carcinoma death. Extrathyroid extension also independently predicted these recurrences and carcinoma death, although hazard ratios were lower than for large node metastasis. Age 55 years or older, in contrast, was the strongest predictor of carcinoma death. Extranodal tumor extension did not independently affect recurrence, but it had prognostic significance for carcinoma death. These findings suggest that recurring PTC lesions of older patients and/or extranodal tumor extensions are difficult to control and very progressive.

Keywords

Papillary Thyroid Carcinoma Extrathyroid Extension Papillary Thyroid Carcinoma Patient Central Node Dissection Modify Radical Neck Dissection 
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.

References

  1. 1.
    Ito Y, Miyauchi A (2009) Prognostic factors and therapeutic strategies for differentiated carcinoma of the thyroid. Endocrine J 56:177–192CrossRefGoogle Scholar
  2. 2.
    Ito Y, Higashiyama T, Takamura Y et al (2007) Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis: validity of prophylactic modified radical neck dissection. World J Surg 31:2085–2091. doi: 10.1007/s00268-007-9224-y PubMedCrossRefGoogle Scholar
  3. 3.
    Ito Y, Miyauchi A, Jikuzono T et al (2007) Risk factors contributing to a poor prognosis of papillary thyroid carcinoma; validity of UICC/AJCC TNM classification and stage grouping. World J Surg 31:838–848. doi: 10.1007/200268-006-0455-0 PubMedCrossRefGoogle Scholar
  4. 4.
    Ito Y, Ichihara K, Masuoka H et al (2010) Establishment of an intraoperative staging system (iStage) by improving UICC TNM classification system for papillary thyroid carcinoma. World J Surg 34:2570–2580. doi: 10.1007/s00268-010-0710-2 PubMedCrossRefGoogle Scholar
  5. 5.
    Ito Y, Tomoda C, Uruno T et al (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786. doi: 10.1007/s00268-005-0270-z PubMedCrossRefGoogle Scholar
  6. 6.
    Ito Y, Hirokawa M, Jikuzono T et al (2007) Extranodal tumor extension to adjacent organs predicts a worse cause-specific survival in patients with papillary thyroid carcinoma. World J Surg 31:1196–1203. doi: 10.1007/s00268-007-9042-2 CrossRefGoogle Scholar
  7. 7.
    Sobin LH, Wittekind CH (eds) (2002) Union for International Cancer Control : TNM classification of malignant tumors, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  8. 8.
    Ito Y, Fukushima M, Tomoda C et al (2009) Prognosis of patients with papillary carcinoma having clinically apparent metastasis to the lateral compartment. Endocrine J 56:759–766CrossRefGoogle Scholar
  9. 9.
    Guidelines for Management of Thyroid Tumor—The Japanese Society of Thyroid Surgery/The Japanese Society of Endocrine Surgeons, Tokyo, Kanehara PressGoogle Scholar
  10. 10.
    British Thyroid Association (2007) Guidelines for the Management of Thyroid Cancer, Second Edition, Available at http://www.british-thyroid-association.org/news/Docs/Thyroid_cancer_guidelines_2007.pdf
  11. 11.
    Cooper D, Doherty G, Haugen B et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1213PubMedCrossRefGoogle Scholar
  12. 12.
    National Comprehensive Cancer Network (2010) NCCN Clinical Practice Guidelines in Oncology. Thyroid Carcinoma, V. 1. Available at http://www.nccn.org/professionals/physician_gls/PDF/thyroid/pdf
  13. 13.
    Thyroid Carcinoma Task Force (2001) AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract 7:202–220Google Scholar
  14. 14.
    Sugitani I, Kasai N, Fujimoto Y et al (2004) A novel classification system for patients with PTC: addition of the new variable of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135:139–148PubMedCrossRefGoogle Scholar
  15. 15.
    Ito Y, Masuoka H, Fukushima M et al (2010) Excellent prognosis of patients with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy. World J Surg 34:1285–1290PubMedCrossRefGoogle Scholar
  16. 16.
    Ito Y, Kudo T, Kihara M et al. (2011) Prognosis of low-risk papillary thyroid carcinoma patients: its relationship with the size of primary tumors. Endocr J epub ahead of print, November 9, 2011Google Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Yasuhiro Ito
    • 1
    Email author
  • Takumi Kudo
    • 2
  • Kaoru Kobayashi
    • 1
  • Akihiro Miya
    • 1
  • Kiyoshi Ichihara
    • 3
  • Akira Miyauchi
    • 1
  1. 1.Department of SurgeryKuma HospitalChuo-ku, KobeJapan
  2. 2.Department of Internal MedicineKuma HospitalChuo-ku, KobeJapan
  3. 3.Department of Clinical Laboratory Sciences, Faculty of Health ScienceYamaguchi University School of MedicineYamaguchiJapan

Personalised recommendations