Skip to main content


Log in

Prognosis of Patients with Papillary Thyroid Carcinoma Showing Postoperative Recurrence to the Central Neck

  • Published:
World Journal of Surgery Aims and scope Submit manuscript



The prognosis and prognostic factors of papillary carcinoma have been intensively investigated. However, details of patient prognosis after the detection of recurrence remain unclear. In this study, we investigated the prognosis of papillary carcinoma patients after showing recurrence in the central neck.


We enrolled 403 patients who underwent initial, locally curative surgery for papillary carcinoma in Kuma Hospital between 1987 and 2004 and then showed recurrence in the central neck during follow-up.


The 5- and 10-year cause-specific survival (CSS) rates for patients after initial recurrence to the lymph node were 95 and 88%, respectively. Age >45 years at recurrence and some clinicopathologic features at the initial surgery—aggressive histology, tumor >4 cm, lymph node metastasis >3 cm, significant extrathyroid extension—affected the CSS of patients. Except for extrathyroidal extension, these features were independent prognostic factors on a multivariate analysis. Patients initially showing recurrence to subcutaneous tissue suspected of needle tract implantation during fine-needle aspiration biopsy and those showing recurrence to the remnant thyroid demonstrated an excellent prognosis; none of these patients died of carcinoma during follow-up. The prognosis of patients showing initial recurrence to the thyroid bed or perithyroid tissue was significantly worse than that of those with initial recurrence to the lymph node; their 5- and 10-year CSS rates were 88 and 79%, respectively.


Aggressive histology, the size of the primary lesion and of the lymph node metastasis, and age at recurrence independently affected the prognosis of patients showing initial recurrence to the lymph node. Prognoses of patients with recurrence to the subcutaneous tissue or remnant thyroid were excellent. However, patients initially showing recurrence to the thyroid bed or perithyroid tissue exhibited a worse prognosis; and careful second surgery and subsequent follow-up are thus mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. British Thyroid Association (2007) Guidelines for the management of thyroid cancer. 2nd edn.

  2. 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 19:1167–1213

    Article  PubMed  Google Scholar 

  3. National Comprehensive Cancer Network (2010) NCCN Clinical Practice Guidelines in Oncology. Thyroid Carcinoma. Vol 1.

  4. Thyroid Carcinoma Task Force (2001) AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. Endocr Pract 7:202–220

    Google Scholar 

  5. Japanese Society of Thyroid Surgery/Japanese Society of Endocrine Surgeons (2010) Guidelines for management of thyroid tumor. Kanehara Press, Tokyo

    Google Scholar 

  6. Ito Y, Miyauchi A (2009) Prognostic factors and therapeutic strategies for differentiated carcinoma of the thyroid. Endocr J 32:729–739

    Google Scholar 

  7. Ito Y, Kakudo K, Hirokawa M, Fukushima M, Yabuta T, Tomoda C, Inoue H, Kihara M, Higashiyama T, Uruno T, Takamura Y, MIya A, Kobayashi K, Matsuzuka F, Miyauchi A (2009) Biological behavior and prognosis of familial papillary thyroid carcinoma. Surgery 145:100–105

    Article  PubMed  Google Scholar 

  8. Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, Miya A, Kobayashi K, Matsuzuka F, Amino N, Kuma K (2005) Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29:483–485

    Article  PubMed  Google Scholar 

  9. Sakamoto A, Kasai N, Sugano H (1983) Poorly differentiated carcinoma of the thyroid: a clinicopathologic entity for a high risk group of papillary and follicular carcinomas. Cancer 52:1849–1855

    Article  PubMed  CAS  Google Scholar 

  10. Japanese Society of Thyroid Surgery (2005) General rules for the description of thyroid cancer, 6th edn. Kanehara Press, Tokyo

    Google Scholar 

  11. Ito Y, Tomoda C, Uruno T et al (2005) Needle tract implantation of papillary thyroid carcinoma after fine-needle aspiration biopsy. World J Surg 29:1544–1549

    Article  PubMed  Google Scholar 

  12. Lin JD, Hsueh C, Chao TC (2009) Early recurrence of papillary and follicular thyroid carcinoma predicts a worse outcome. Thyroid 19:1053–1059

    Article  PubMed  Google Scholar 

  13. Ito Y, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Miyauchi A (2010) Clinical outcomes of patients with papillary thyroid carcinoma after the detection of distant recurrence. World J Surg (in press)

  14. Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A (2004) A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135:139–148

    Article  PubMed  Google Scholar 

  15. Ito Y, Fukushima M, Tomoda C et al (2009) Prognosis of patients with papillary carcinoma having clinically apparent metastasis to the lateral compartment. Endocr J 56:759–766

    Article  PubMed  Google Scholar 

  16. Silronen P, Louhimo J, Nordling S, Ristimaki A, Maenpaa H, Haapiainen R, Halund C (2005) Prognostic factors in papillary thyroid cancer: an evaluation of 601 consecutive patients. Tumour Biol 26:57–64

    Article  Google Scholar 

  17. Cady B, Rosai R (1988) An expanded view of risk group definition in differentiated thyroid carcinoma. Surgery 104:947–953

    PubMed  CAS  Google Scholar 

  18. Hay ID, Bergstrahl EJ, Goellner JR, Ebersold JR, Grant CS (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058

    PubMed  CAS  Google Scholar 

  19. Gilliland FD, Hunt WC, Morris DM, Key CR (1997) Prognostic factors for thyroid carcinoma: a population-based study of 15, 698 cases from the Surveillance, Epidermiology and End Results (SEER) program 1973–1991. Cancer 79:564–573

    Article  PubMed  CAS  Google Scholar 

  20. Ito Y, Masuoka H, Fukushima M et al (2010) Excellent prognosis of patient with solitary T1N0M0 papillary thyroid carcinoma who underwent thyroidectomy and elective lymph node dissection without radioiodine therapy. World J Surg 34:1285–1290

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yasuhiro Ito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ito, Y., Higashiyama, T., Takamura, Y. et al. Prognosis of Patients with Papillary Thyroid Carcinoma Showing Postoperative Recurrence to the Central Neck. World J Surg 35, 767–772 (2011).

Download citation

  • Published:

  • Issue Date:

  • DOI: