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Endocrine

22-09-2023 | Thyroidectomy | Original Article

The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study

Authors: Sayid Shafi Zuhur, Hunkar Aggul, Ugur Avci, Selvinaz Erol, Mazhar Muslum Tuna, Serhat Uysal, Gulhan Akbaba, Faruk Kilinc, Merve Catak, Sakin Tekin, Beyza Olcay Ozturk, Halise Cinar Yavuz, Pinar Kadioglu, Nese Cinar, Taner Bayraktaroglu, Birol Topcu, Yuksel Altuntas, Gulsah Elbuken

Published in: Endocrine

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Abstract

Objectives

Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC.

Methods

The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox’s proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method.

Results

This study included 1013 patients (84% females), with a mean follow-up period of 62.5 ± 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02–5.81, p = 0.043; HR: 4.38, 95% CI: 1.7–11.2, p = 0.002, respectively).

Conclusions

In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.
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Metadata
Title
The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study
Authors
Sayid Shafi Zuhur
Hunkar Aggul
Ugur Avci
Selvinaz Erol
Mazhar Muslum Tuna
Serhat Uysal
Gulhan Akbaba
Faruk Kilinc
Merve Catak
Sakin Tekin
Beyza Olcay Ozturk
Halise Cinar Yavuz
Pinar Kadioglu
Nese Cinar
Taner Bayraktaroglu
Birol Topcu
Yuksel Altuntas
Gulsah Elbuken
Publication date
22-09-2023
Publisher
Springer US
Published in
Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-023-03533-1
Webinar | 08-11-2023 | 18:00 (CET)

Keynote Webinar | Spotlight on Diet and Diabetes

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An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. Highlights include discussion of the recent EASD guidelines, therapeutic diets, food types and processing, plus psychological factors that influence patient success, and the drivers of healthy eating and diabetes control.
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