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Factors Affecting the Locoregional Recurrence of Conventional Papillary Thyroid Carcinoma After Surgery: A Retrospective Analysis of 3381 Patients

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Papillary thyroid carcinoma (PTC) does recur, despite its favorable long-term outcome. The incidence of thyroid cancer in South Korea increased during the 1990s, then increased rapidly after the turn of the century. In 2011, the rate of thyroid cancer diagnoses was 15 times that observed in 1993. The present study aimed to identify factors associated with the locoregional recurrence of recently increasing conventional PTC.

Methods

The records of 3381 patients with conventional PTC were reviewed for this retrospective cohort study. Between January 2004 and January 2012, these patients underwent ultrasonography, computed tomography, and preoperative and total thyroidectomy with central neck dissection. Disease recurrence was defined as structural evidence of disease following the remission period.

Results

Median length of follow-up was 5.6 (range 2.1–10.1) years. Of 3381 patients, 75 (2.2 %) experienced recurrence. The univariate analysis suggested that locoregional recurrence was associated with tumor size, multifocality, extrathyroidal extension (ETE), lymph node metastasis, lymphatic invasion, vascular invasion, and positive surgical margin. However, multivariate analysis showed that only tumor size (p < 0.001), bilaterality (p < 0.001), gross ETE (p = 0.049), lymph node metastasis (p < 0.001), and vascular invasion (p = 0.013) were independently associated with locoregional recurrence.

Conclusions

Tumor size, bilaterality, gross ETE, lymph node metastasis, and vascular invasion were associated with locoregional recurrence. Evaluation of these prognostic factors appears to help identify patients who require close monitoring.

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Acknowledgment

All statistical analyses were supported by the Medical Research Collaborating Center, Seoul National University and Seoul National University Hospital, Seoul, Korea. The authors are indebted to J. Patrick Barron (Professor Emeritus of Tokyo Medical University and Adjunct Professor of Seoul National University Bundang Hospital) for his editorial work.

Disclosures

Yong Joon Suh, Hyungju Kwon, Su-jin Kim, June Young Choi, Kyu Eun Lee, Young Joo Park, Do Joon Park, and Yeo-Kyu Youn declare no conflicts of interest and disclose no financial ties.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea

    Yong Joon Suh MD, Hyungju Kwon MD, Su-jin Kim MD, Kyu Eun Lee MD, PhD & Yeo-Kyu Youn MD, PhD

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Yong Joon Suh MD, Hyungju Kwon MD, Su-jin Kim MD, June Young Choi MD, Kyu Eun Lee MD, PhD, Young Joo Park MD, PhD, Do Joon Park MD, PhD & Yeo-Kyu Youn MD, PhD

  3. Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea

    June Young Choi MD

  4. Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea

    Young Joo Park MD, PhD & Do Joon Park MD, PhD

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  1. Yong Joon Suh MD
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Correspondence to Kyu Eun Lee MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 A flow diagram of the study design. PTC papillary thyroid carcinoma (TIFF 38 kb)

10434_2015_4448_MOESM2_ESM.tif

Supplementary material 2 The risk and rate of recurrence according to age. The relative hazard ratio (HR) in each decade was illustrated by the blue line. Gray shading indicates 95% confidence interval. (TIFF 111 kb)

10434_2015_4448_MOESM3_ESM.tif

Supplementary material 3 The positive lymph node number of 2 showed the highest accuracy, although the recurrence rate was significantly higher in the group with an initial ratio ≥0.3. A ROC curve with the number of 2 resulted in a sensitivity of 80.7% and a specificity of 79% (AUC=0.83, 95% confidence interval: 0.77-0.88, p<.001). ROC receiver operating characteristic curve, LN lymph node, AUC area under the curve (TIFF 35 kb)

Supplementary material 4 (DOCX 15 kb)

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Suh, Y.J., Kwon, H., Kim, Sj. et al. Factors Affecting the Locoregional Recurrence of Conventional Papillary Thyroid Carcinoma After Surgery: A Retrospective Analysis of 3381 Patients. Ann Surg Oncol 22, 3543–3549 (2015). https://doi.org/10.1245/s10434-015-4448-9

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  • DOI: https://doi.org/10.1245/s10434-015-4448-9

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