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Extent of Extrathyroidal Extension as a Significant Predictor of Nodal Metastasis and Extranodal Extension in Patients with Papillary Thyroid Carcinoma

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

Abstract

Background

Extrathyroidal extension (ETE) and extranodal extension (ENE) indicate poor prognosis for patients with papillary thyroid carcinoma (PTC). The relationships among ETE, ENE, and nodal metastasis (N1) have not been thoroughly studied. In this study, we examined the relationships among the extent of ETE, N1, ENE, and posttreatment recurrence in patients with PTC.

Methods

This study enrolled 1693 consecutive patients with previously untreated PTC who underwent thyroidectomy between 2006 and 2009. The extent of ETE was graded based on intraoperative and pathological findings, and central and lateral neck (N1b) nodal metastases and ENE were pathologically determined. Univariate and multivariate analyses were used to identify the association of clinicopathological factors with recurrence-free survival (RFS) and to define the relationships among the extent of ETE, N1, and ENE.

Results

Of 1693 patients, 1087 (64.2 %) had ETE and 201 (11.9 %) had ENE. Pathologically positive lymph nodes were found in 783 patients (46.2 %), of whom 236 (30.1 %) had N1b. During the median follow-up of 86 months, 90 (5.3 %) patients had recurrences. Multivariate analyses showed that multifocality, ETE, T and N classification, the risk of structural recurrence proposed by the American Thyroid Association, and ENE were independent variables for RFS (P < .05). Patients with macroscopic ETE had a 13-fold increased risk of recurrence, and ETE had significant relationships with N1, N1b, and ENE (all P < .001).

Conclusions

Local extension, nodal involvement, and ENE contribute to posttreatment recurrence of PTC. Macroscopic ETE predicts nodal metastasis and ENE, which are adverse pathologic features.

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Acknowledgment

This study was supported by a Grant (No. 2015R1A2A1A15054540) from the Basic Science Research Program through the National Research Foundation of Korea (NRF), Ministry of Science, ICT, and Future Planning and a Grant (No. HI15C2920) from the Korean Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), Ministry of Health & Welfare, Seoul, Republic of Korea (J.L. Roh).

Disclosure

The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Ji Won Kim MD, Jong-Lyel Roh MD, PhD, Seung-Ho Choi MD, PhD, Soon Yuhl Nam MD, PhD & Sang Yoon Kim MD, PhD

  2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Gyungyup Gong MD, PhD & Kyung-Ja Cho MD, PhD

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  1. Ji Won Kim MD
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Correspondence to Jong-Lyel Roh MD, PhD.

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Kim, J.W., Roh, JL., Gong, G. et al. Extent of Extrathyroidal Extension as a Significant Predictor of Nodal Metastasis and Extranodal Extension in Patients with Papillary Thyroid Carcinoma. Ann Surg Oncol 24, 460–468 (2017). https://doi.org/10.1245/s10434-016-5594-4

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  • DOI: https://doi.org/10.1245/s10434-016-5594-4

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