Clin Exp Otorhinolaryngol.  2024 Nov;17(4):336-345. 10.21053/ceo.2024.00162.

Clinical Significance of Gross Extrathyroidal Extension to Only the Strap Muscle According to Tumor Size in Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis

• Won HR
• Kim JW
• Son HO
• Yi S
• Chang JW
• Koo BS

• KMID: 2561367
• DOI: http://doi.org/10.21053/ceo.2024.00162

Abstract

Objectives
. The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size.
Methods
. Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted.
Results
. Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis.
Conclusion
. gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.

Keyword

Thyroid Cancer; Neck Muscles; Extrathyroidal Extension; Strap Muscle; Prognosis

Figure

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  Fig. 1. Flow diagram showing the selection of studies for inclusion in the systematic review and meta-analysis.

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  Fig. 2. Recurrence rate in patients with gross extrathyroidal extension (ETE) only affecting the strap muscle compared with (A) patients without ETE and (B) those with extensive ETE.

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  Fig. 3. (A) Recurrence-free survival, (B) disease-specific survival, and (C) overall survival in patients with gross extrathyroidal extension (ETE) only affecting the strap muscle compared to patients without ETE.

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  Fig. 4. Comparison of lymph node metastasis in patients with gross extrathyroidal extension (ETE) only affecting the strap muscle and without ETE. (A) Total lymph node metastasis, (B) N1a (central lymph node metastasis), and (C) N1b (lateral lymph node metastasis).

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  Fig. 5. (A) Recurrence rate, (B) recurrence-free survival, (C) disease-specific survival, and (D) lymph node metastasis rate in patients with differentiated thyroid cancer measuring 4 cm or less with gross extrathyroidal extension (ETE) only affecting the strap muscle compared to patients without ETE.

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