2011, Number 2
Low-risk papillary thyroid cancer recurrence in patients treated with total thyroidectomy and adjuvant therapy vs. patients treated with partial thyroidectomy
PDF size: 307.26 Kb.
ABSTRACTBackground: Surgical extension for treatment of patients with low-risk papillary thyroid carcinoma is still controversial. We undertook this study to assess if there is a difference in recurrence between patients undergoing total thyroidectomy plus adjuvant therapy and patients treated with only partial thyroidectomy.
Methods: We conducted a longitudinal, observational, analytical study in patients with histopathological diagnosis of low-risk papillary thyroid carcinoma followed for at least 10 years. Patients were divided into two groups: Group 1: Patients treated with total thyroidectomy plus adjuvant therapy (TT) and Group 2: Patients treated with only partial thyroidectomy without adjuvant therapy (HT). Descriptive and inferential statistical methods were used.
Results: AMES: 184 patients, recurrence in 5/23 HT and 7/161 TT (p = 0.0016); MACIS: 170 patients, recurrence in 5/24 HT and 5/146 TT (p = 0.0008); DeGroot: 92 patients, recurrence in 3/19 HT and 2/73 TT (p = 0.0254); TNM: 150 patients, recurrence in 5/22 HT and 7/128 TT (p = 0.0058). The time interval for local recurrences was higher in comparison to regional recurrences (p ‹0.05). In all classifications, recurrences occur mainly with regional metastatic disease (60%). Multifocality, bilateral disease and extracapsular disease showed no statistical difference. There was one incidental injury to a recurrent laryngeal nerve and this was repaired during the same surgical procedure. There was no morbidity due to hypoparathyroidism.
Conclusions: Patients classified as low risk according to any of the studied classifications have a higher risk for recurrence when treated with hemithyroidectomy than when treated with total thyroidectomy plus adjuvant therapy.
Gemsenjäger E, Heitz PU, Martina B. Selective treatment of differentiated thyroid carcinoma. World J Surg 1997;21:546-551.
Chow TL, Choi CY, Lam SH. Disease control of differentiated thyroid carcinomas by hemithyroidectomy. Singapore Med J 2010;51:311-314.
Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088-1095.
Cady B. Our AMES is true: how an old concept still hit the mark: or risk group assignment points the arrow to rational therapy selection in differentiated thyroid cancer. Am J Surg 1997;174:462-468.
Shaha AR, Shah JP, Loree TR. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol 1996;3:534-538.
Hassanain M, Wexler M. Conservative management of well-differentiated thyroid cancer. Can J Surg 2010;53:109-118.
Shrestha SK, Joshi MR, Sharma SK. Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma. Kathmandu Univ Med J (KUMJ) 2005;3:35-38.
Eroğlu A, Unal M, Kocaoğlu H. Total thyroidectomy for differentiated thyroid carcinoma: primary and secondary operations. Eur J Surg Oncol 1998;24:283-287.
Davidson HC, Park BJ, Johnson JT. Papillary thyroid cancer: controversies in the management of neck metastasis. Laryngoscope 2008;118:2161-2165.
Sosa JA, Udelsman R. Total thyroidectomy for differentiated thyroid cancer. J Surg Oncol 2006;94:701-707.
Besic N, Zgajnar J, Hocevar M, Petric R. Extent of thyroidectomy and lymphadenectomy in 254 patients with papillary thyroid microcarcinoma: a single-institution experience. Ann Surg Oncol 2009;16:920-928.
Verburg FA, de Keizer B, Lam MG, de Klerk JM, Lips CJ, Borel-Rinkes IH, et al. Persistent disease in patients with papillary thyroid carcinoma and lymph node metastases after surgery and iodine-131 ablation. World J Surg 2007;31:2309-2314.
Cross S, Wei JP, Kim S, Brams DM. Selective surgery and adjuvant therapy based on risk classifications of well-differentiated thyroid cancer. J Surg Oncol 2006;94:678-682.
Son YI, Jeong HS, Baek CH, Chung MK, Ryu J, Chung JH, et al. Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol 2008;15:2020-2026.
Verburg FA, Mäder U, Luster M, Reiners C. Histology does not influence prognosis in differentiated thyroid carcinoma when accounting for age, tumour diameter, invasive growth and metastases. Eur J Endocrinol 2009;160:619-624.
Dzodic R, Markovic I, Inic M, Jokic N, Djurisic I, Zegarac M, et al. Sentinel lymph node biopsy may be used to support the decision to perform modified radical neck dissection in differentiated thyroid carcinoma. World J Surg 2006;30:841-846.
Mazzaferri EL, Young RL, Oertel JE, Kemmerer WT, Page CP. Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine 1977;56:171-196.
Byar DP, Green SB, Dor P, Williams ED, Colon J, van Gilse HA, et al. A prognostic index for thyroid carcinoma. A study of the E.O.R.T.C. Thyroid Cancer Cooperative Group. Eur J Cancer 1979;15:1033-1041.
Simpson WJ, McKinney SE. Canadian survey of thyroid cancer. Can Med Assoc J 1985;132:925-931.
Hoffman HT, Karnell LH, Funk GF, Robinson RA, Menck HR. The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:951-962.
Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary carcinoma: a reprospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088-1094.
Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988;104:947-953.
Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1997 patients surgically treated at one institution during 1940 through 1989. Surgery 1993;114:1050-1058.
DeGroot L, Kaplan E. Natural History, Treatment, and Course of Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 1990;71:414-424.
Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and metaanalysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope 2009;119:1135-1139.
Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 2007;246:375-381.
Misiolek M, Waler J, Namyslowski G, Kucharzewski M, Podwinski A, Czecior E. Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem. Eur Arch Otorhinolaryngol 2001;258:460-462.
Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg 2007;392:685-691.
Sevim T. Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma. Clin Otolaryngol 2007;32:378-383.
Filho JG, Kowalski LP. Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. Am J Otolaryngol 2004;25:225-230.
Filho JG, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 2005;132:490-494.
Hurtado-López LM. La extensión del cáncer bien diferenciado de tiroides y su relación con la morbilidad quirúrgica. Cir Cir 2007;75:71-74.
Lind P, Kohlfürst S. Respective roles of thyroglobulin, radioiodine imaging, and positron emission tomography in the assessment of thyroid cancer. Semin Nucl Med 2006;36:194-205.
Salvatore B, Paone G, Klain M, Storto G, Nicolai E, D’Amico D, et al. Fluorodeoxyglucose PET/CT in patients with differentiated thyroid cancer and elevated thyroglobulin after total thyroidectomy and 131I ablation. QJ Nucl Med Mol Imaging 2008;52:2-8.
Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447-1463.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214.
Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787-803.
Pitoia F, Ward L, Wohllk N, Friguglietti C, Tomimori E, Gauna A, et al. Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arq Bras Endocrinol Metabol 2009;53:884-887.
LiVolsi VA. Papillary carcinoma tall cell variant (TCV): a review. Endocr Pathol 2010;21:12-15.
Sheu SY, Grabellus F, Schwertheim S, Worm K, Broecker-Preuss M, Schmid KW. Differential miRNA expression profiles in variants of papillary thyroid carcinoma and encapsulated follicular thyroid tumours. Br J Cancer 2010;102:376-382.
Pita JM, Banito A, Cavaco BM, Leite V. Gene expression profiling associated with the progression to poorly differentiated thyroid carcinomas. Br J Cancer 2009;101:1782-1791.
Mazzaferri EL. What is the optimal initial treatment of low-risk papillary thyroid cancer (and why is it controversial)? Oncology 2009;23:579-588.
Arora N, Turbendian HK, Kato MA, Moo TA, Zarnegar R, Fahey TJ 3rd. Papillary thyroid carcinoma and microcarcinoma: is there a need to distinguish the two? Thyroid 2009;19:473-477.
Giusti F, Falchetti A, Franceschelli F, Marini F, Tanini A, Brandi ML. Thyroid cancer: current molecular perspectives. J Oncol 2010:351679. Epub 2010 Mar 29.