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Annals of Surgical Oncology

, Volume 26, Issue 13, pp 4466–4471 | Cite as

Clinical Significance of Gross Invasion of Strap Muscles in Patients With 1- to 4-cm-Sized Papillary Thyroid Carcinoma Undergoing Lobectomy

  • Eyun SongEmail author
  • Won Woong Kim
  • Min Ji Jeon
  • Tae-Yon Sung
  • Dong Eun Song
  • Tae Yong Kim
  • Ki Wook Chung
  • Won Bae Kim
  • Young Kee Shong
  • Suck Joon Hong
  • Yu-Mi LeeEmail author
  • Won Gu KimEmail author
Head and Neck Oncology

Abstract

Background

Given the emerging evidence supporting the lack of prognostic significance of gross extrathyroidal extension invading only strap muscles (strap-gETE), this study investigated whether lobectomy is feasible for patients with strap-gETE.

Methods

A retrospective cohort study was conducted with 636 patients who had 1- to 4-cm-sized papillary thyroid carcinoma (PTC) treated with thyroid lobectomy. Patients with gross invasion of perithyroidal organs other than strap muscles or synchronous distant metastasis were excluded from the study. Disease-free survival (DFS) was compared according to the presence of strap-gETE.

Results

Strap-gETE was present in 50 patients (7.9%), with the remaining 586 patients (92.1%) showing no evidence of gETE. During the median follow-up period of 7.4 years, 6% of the patients with strap-gETE and 5.1% of the patients without gETE experienced structural persistent/recurrent disease (p = 0.99). No differences in DFS were observed between the two groups (hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.38–4.08; p = 0.720). After adjustment for five major risk factors (age, gender, tumor size, multifocality, and cervical lymph node metastasis status) in the multivariate analysis, the presence of strap-gETE did not exhibit an independent role in the development of structural persistent/recurrent disease (HR 1.05; 95% CI 0.24–4.53, p = 0.950).

Conclusions

Strap-gETE did not increase the risk of structural persistent/recurrent disease for the patients who underwent lobectomy for 1- to 4-cm-sized PTC. The study data support the limited role of strap-gETE in clinical outcomes and may broaden the indications for lobectomy for patients with PTCs.

Notes

Acknowledgment

This study was supported by a Grant (No. 2018-790) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.

Conflict of interest

There are no conflicts of interest.

Supplementary material

10434_2019_7778_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)

References

  1. 1.
    American Joint Committee on Cancer. Thyroid gland. In: Fleming ID, Cooper JS, Henson DE, et al., editors. AJCC manual for staging of cancer. 5th ed. Philadelphia: Lippincott-Raven; 1997, p. 59–64.Google Scholar
  2. 2.
    Gemsenjager E, Heitz PU, Seifert B, Martina B, Schweizer I. Differentiated thyroid carcinoma: follow-up of 264 patients from one institution for up to 25 years. Swiss Med Wkly. 2001;131:157–63.PubMedGoogle Scholar
  3. 3.
    Ito Y, Tomoda C, Uruno T, et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg. 2006;30:780–6.CrossRefGoogle Scholar
  4. 4.
    Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. Philadelphia: Springer; 2002.CrossRefGoogle Scholar
  5. 5.
    Tuttle MR, Morris LF, Haugen BR, et al. Thyroid-differentiated and anaplastic carcinoma. In: Amin MB, Edge SB, Greeme FL, et al., editors. AJCC cancer staging manual. 8th ed. Philadelphia: Springer; 2017, p. 873–890.Google Scholar
  6. 6.
    Arora N, Turbendian HK, Scognamiglio T, et al. Extrathyroidal extension is not all equal: implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery. 2008;144:942–7; (discussion 947–948).CrossRefGoogle Scholar
  7. 7.
    Shin JH, Ha TK, Park HK, et al. Implication of minimal extrathyroidal extension as a prognostic factor in papillary thyroid carcinoma. Int J Surg. 2013;11:944–7.CrossRefGoogle Scholar
  8. 8.
    Radowsky JS, Howard RS, Burch HB, Stojadinovic A. Impact of degree of extrathyroidal extension of disease on papillary thyroid cancer outcome. Thyroid. 2014;24:241–4.CrossRefGoogle Scholar
  9. 9.
    McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940–1990. Head Neck. 1994;16:165–72.CrossRefGoogle Scholar
  10. 10.
    Iniguez-Ariza NM, Brito JP. Management of low-risk papillary thyroid cancer. Endocrinol Metab Seoul. 2018;33:185–94.CrossRefGoogle Scholar
  11. 11.
    Park SY, Kim HI, Kim JH, et al. Prognostic significance of gross extrathyroidal extension invading only strap muscles in differentiated thyroid carcinoma. Br J Surg. 2018;105:1155–62.CrossRefGoogle Scholar
  12. 12.
    Amit M, Boonsripitayanon M, Goepfert RP, et al. Extrathyroidal extension: does strap muscle invasion alone influence recurrence and survival in patients with differentiated thyroid cancer? Ann Surg Oncol. 2018;25:3380–8.CrossRefGoogle Scholar
  13. 13.
    Song E, Lee YM, Oh HS, et al. A relook at the T stage of differentiated thyroid carcinoma with a focus on gross extrathyroidal extension. Thyroid. 2019;29:202–8.CrossRefGoogle Scholar
  14. 14.
    Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.CrossRefGoogle Scholar
  15. 15.
    Jukkola A, Bloigu R, Ebeling T, Salmela P, Blanco G. Prognostic factors in differentiated thyroid carcinomas and their implications for current staging classifications. Endocr Relat Cancer. 2004;11:571–9.CrossRefGoogle Scholar
  16. 16.
    Kwon H, Jeon MJ, Kim WG, et al. A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: a retrospective individual risk factor-matched cohort study. Eur J Endocrinol. 2017;176:371–8.CrossRefGoogle Scholar
  17. 17.
    Sung TY, Cho JW, Lee YM, et al. Dynamic risk stratification in stage I papillary thyroid cancer patients younger than 45 years of age. Thyroid. 2017;27:1400–7.CrossRefGoogle Scholar
  18. 18.
    Song E, Oh HS, Jeon MJ, et al. The value of preoperative antithyroidperoxidase antibody as a novel predictor of recurrence in papillary thyroid carcinoma. Int J Cancer. 2019;144:1414–20.CrossRefGoogle Scholar
  19. 19.
    Kim BW, Yousman W, Wong WX, Cheng C, McAninch EA. Less is more: comparing the 2015 and 2009 American Thyroid Association guidelines for thyroid nodules and cancer. Thyroid. 2016;26:759–64.CrossRefGoogle Scholar
  20. 20.
    Schlumberger M, Leboulleux S, Catargi B, et al. Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised phase 3 equivalence trial. Lancet Diabetes Endocrinol. 2018;6:618–26.CrossRefGoogle Scholar
  21. 21.
    Kandil E, Krishnan B, Noureldine SI, Yao L, Tufano RP. Hemithyroidectomy: a meta-analysis of postoperative need for hormone replacement and complications. ORL J Otorhinolaryngol Relat Spec. 2013;75:6–17.CrossRefGoogle Scholar
  22. 22.
    Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21:3844–52.CrossRefGoogle Scholar
  23. 23.
    Park S, Jeon MJ, Song E, et al. Clinical features of early and late postoperative hypothyroidism after lobectomy. J Clin Endocrinol Metab. 2017;102:1317–24.CrossRefGoogle Scholar
  24. 24.
    Tam S, Boonsripitayanon M, Amit M, et al. Survival in differentiated thyroid cancer: comparing the AJCC Cancer Staging Seventh and Eighth Editions. Thyroid. 2018;28:1301–10.CrossRefGoogle Scholar
  25. 25.
    Amit M, Boonsripitayanon M, Zafereo ME. ASO author reflections: strap muscle invasion does not influence recurrence and survival in patients with differentiated thyroid cancer. Ann Surg Oncol. 2018;25:892–93.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Eyun Song
    • 1
    Email author
  • Won Woong Kim
    • 2
  • Min Ji Jeon
    • 1
  • Tae-Yon Sung
    • 2
  • Dong Eun Song
    • 3
  • Tae Yong Kim
    • 1
  • Ki Wook Chung
    • 2
  • Won Bae Kim
    • 1
  • Young Kee Shong
    • 1
  • Suck Joon Hong
    • 2
  • Yu-Mi Lee
    • 2
    Email author
  • Won Gu Kim
    • 1
    Email author
  1. 1.Division of Endocrinology and Metabolism, Department of Internal MedicineAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of PathologyAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea

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