Management of 2-4 cm Papillary Thyroid Carcinoma: Risk of Recurrence Compared to 1-2 cm and >4 cm

Abstract

Purpose Clinicians still debate how to manage 2–4 cm papillary thyroid carcinoma (PTC). To understand the characteristics and prognosis of these tumors, we compared clinicopathological prognostic factors and prognosis among 1–2 cm, 2–4 cm, and >4 cm PTC.

Methods We retrospectively reviewed the medical records of 2,079 patients with primary PTC >1 cm who were diagnosed between 2002 and 2017.

Results The patients' mean age was 47.9±12.5 years, and 83.2% were women. The follow-up period was 81.1±41.8 months. The tumor recurred in 138 patients (6.6%), and thyroid cancer-related death developed in 3 cases (0.1%). As tumor size increased, so did the proportion of male patients, lymphovascular invasion, resection margin positivity, lymph node (LN) metastasis, metastasis in >5 LNs, T4, N stage, and M stage. Recurrence increased linearly according to tumor size, as did distant metastasis as first recurrence and progression to distant metastasis. Tumor size, N stage, metastasis in >5 LNs, and LN metastasis were significant independent risk factors for PTC recurrence. The recurrence rate of 2–4 cm PTC was 13.4%, while the risk of recurrence was 3 times higher than in 1–2 cm PTC. The 5-year recurrence free survival (RFS) rates of 1–2 cm, 2–4 cm, and >4 cm PTC were 97.0%, 88.0%, and 74.0%, respectively, while the 10-year RFS rates were 95.0%, 84.0%, and 71.0%.

Conclusion The 2–4 cm PTC may be pathologically distinct from 1–2 cm PTC and should be treated differently.