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Does the T1 subdivision correlate with the risk of recurrence of papillary thyroid cancer?

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Abstract

Background

Based on the AJCC seventh TNM classification, T1 intraglandular tumors are subdivided into T1a (≤10 mm) and T1b (11–20 mm), but the differences in prognosis remain controversial. The present study aimed to determine the clinicopathological features and outcomes of T1a and T1b patients.

Methods

A retrospective study of 2518 T1 patients, including 1840 T1a (73 %) and 678 (27 %) T1b patients who underwent surgery for PTC from 1978 to 2014, was conducted. In patients with a preoperative or operative diagnosis of PTC, a total thyroidectomy (TT) with prophylactic (macroscopically N0) or therapeutic (evident N1) lymph node dissection (LND) was performed. Other patients had a TT or partial thyroidectomy without LND. The mean follow-up time was 8.9 ± 8.8 years (median, 6.5 years; range, 1–36.4 years).

Results

A TT was performed in 2273 patients (90 %), including 1184 (52 %) with LND. Other patients (n = 245) had a single lobectomy with isthmectomy. Multifocality, bilaterality, number of tumors, sum of the largest size of all foci, vascular invasion, and (in patients with LND) LN metastases were significantly more frequent in T1b than in T1a patients. Of the 1184 patients with LND, 278 had LN metastases (N1, 23 %), including 136/680 T1a (20 %) and 142/504 (28 %) T1b patients (p = 0.002). These LN metastases were diagnosed after a prophylactic LND in 86/609 T1a (14 %) and 93/440 T1b (21 %) patients (p = 0.001). Recurrences were more frequent in T1b (n = 26, 3.8 %) than in T1a patients (n = 35, 1.9 %, p = 0.005). In the multivariate analysis, independent prognostic factors for recurrence in both groups were the number of tumors, the sum of the largest size of all foci and, in patients who had LND, LN metastases and extranodal extension. For N0-x patients, the recurrence rate was significantly higher in the T1b than in the T1a group (2.4 vs. 0.9 %, respectively, p = 0.005), although this rate was similar in N1 patients (16.2 % for T1a and 9.2 % for T1b patients, p = 0.1). The 5-year disease-free survival rates for T1a and T1b patients were 98.3 and 96.6 %, respectively (p = 0.01).

Conclusion

For PTC patients, T1b had poorer clinicopathological features and increased risk of recurrence than T1a.

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Authors and Affiliations

  1. Departments of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France

    Nathalie Chereau, Christophe Trésallet, Severine Noullet, Gaelle Godiris-Petit & Fabrice Menegaux

  2. Departments of Pathology, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France

    Frédérique Tissier

  3. Departments of Nuclear Medicine, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France

    Laurence Leenhardt

  4. Service de Chirurgie Générale, Hôpital de la Pitie Salpêtrière, 47-83 Boulevard de l’hôpital, 75651 Cedex 13, Paris, France

    Fabrice Menegaux

Authors
  1. Nathalie Chereau
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  2. Christophe Trésallet
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  3. Severine Noullet
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  4. Gaelle Godiris-Petit
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  5. Frédérique Tissier
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  6. Laurence Leenhardt
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  7. Fabrice Menegaux
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Corresponding author

Correspondence to Fabrice Menegaux.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Author contributions

Study conception and design were performed by Chereau, Trésallet, Godiris Petit, Noullet, Tissier, Leenhardt, and Menegaux.

Data acquisition was performed by Chereau, Trésallet, Godiris Petit, Noullet, Tissier, Leenhardt, and Menegaux.

Data analysis and interpretation were performed by Chereau and Menegaux.

Drafting of manuscript was performed by Chereau, Trésallet, and Menegaux.

Critical revision of manuscript was performed by Chereau, Trésallet, Tissier, Leenhardt, and Menegaux.

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Chereau, N., Trésallet, C., Noullet, S. et al. Does the T1 subdivision correlate with the risk of recurrence of papillary thyroid cancer?. Langenbecks Arch Surg 401, 223–230 (2016). https://doi.org/10.1007/s00423-016-1399-y

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  • DOI: https://doi.org/10.1007/s00423-016-1399-y

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