Korean J Endocr Surg.  2010 Dec;10(4):261-265. 10.16956/kjes.2010.10.4.261.

A Study on the Risk Factors for Recurrence of Recurrent Papillary Thyroid Cancer after Surgery

Affiliations
  • 1Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. hnkim80@hotmail.com

Abstract

PURPOSE
Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence.
METHODS
We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed.
RESULTS
Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis.
CONCLUSION
The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence.

Keyword

Papillary thyroid carcinoma; Recurrence; Lymph node metastasis; Neck node dissection

MeSH Terms

Humans
Incidence
Lung
Lymph Nodes
Male
Multivariate Analysis
Neck
Neoplasm Metastasis
Population Characteristics
Prognosis
Recurrence*
Retrospective Studies
Risk Factors*
Thyroid Gland*
Thyroid Neoplasms*

Reference

1.Oritiz S., Rodriquez JM., Parrilla P., Perez D., Morno-Gallego A., Rios A, et al. Recurrent papillary thyroid cancer: Analysis of prognostic factors including the histological variant. Eur J Surg. 2001. 17:406–12.
2.Micheal C., David T., Harold JW. Recurrent thyroid cancer. Role of surgery versus radioactive iodine. Ann Surg. 1994. 219:588–95.
3.Cady B., Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1998. 104:947–53.
4.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 prognostic scoring system. Surgery. 1987. 102:1088–95.
5.Harach HR., Franssila KO., Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer. 1985. 56:531–8.
Article
6.Chow SM., Law SC., Chan JK., Au SK., Yau S., Lau WH. Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003. 98:31–40.
Article
7.Wada N., Duh QY., Sugino K., Iwaski H., Kameyama K., Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003. 237:399–407.
8.Martin JS., Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998. 338:297–306.
Article
9.Grant CS. Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery. 1988. 104:954–62.
10.Clark JR., Lai P., Hall F., Borglund A., Eski S., Freeman JL. Variables predicting distant metastasis in thyroid cancer. Laryngoscope. 2005. 115:661–7.
11.Jemal A., Siegel R., Ward E., Murray T., Xu J., Thun M. Cancer statistics. CA Cancer J Clin. 2007. 57:43–66.
12.Shah JP., Loree TR., Dharker DD., Strong EW., Begg C., Vlamis V. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992. 164:658–61.
Article
13.Scheumann GF., Gimm O., Wegener G., Hundeshagen H., Dralle H. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg. 1994. 18:559–67. discussion 67-8.
Article
14.Shvili Y., Zohar Y., Buller N., Laurian N. Conservative surgical management of invasive differentiated thyroid cancer. J Laryngol Otol. 1985. 99:1255–60.
Article
15.McCaffrey TV., Bergstralh EJ., Hay ID. Locally invasive thyroid carcinoma. Head Neck. 1994. 16:165–72.
16.Park HL., Kwak JK., Kang SS., Kim DY., Kang HG., Shin JY, et al. The analysis of tumor aggressiveness according to tumor size in occult papillary thyroid carcinoma. J Korean Surg Soc. 2007. 73:470–5.
17.DeGroot LJ., Kaplan EL., Mccormick M., Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990. 71:414–24.
Article
18.Haigh PI., Urbach DR., Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer. Ann Surg Oncol. 2005. 12:81–9.
19.Sosa JA., Udelsman R. Total thyroidectomy for differentiated thyroid cancer. J Surg Oncol. 2006. 94:701–7.
Article
20.Mirallie E., Visset J., Sagan C., Hamy A., Le Bodic MF., Paineau J. Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg. 1999. 23:970–3.
21.Watkinson JC., Franklyn JA., Olliff JF. Detection and surgical treatment of cervical lymph nodes in differentiated thyroid cancer. Thyroid. 2006. 16:187–94.
Article
22.Marshall CL., Lee JE., Xing Y., Perrier ND., Edeiken BS., Evans DB, et al. Routine pre-operative Ultrasonography for papillary thyroid cancer: effects on cervical recurrence. Surgery. 2009. 146:1063–72.
Article
Full Text Links
  • KJES
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr