Long-Term Recurrence of Small Papillary Thyroid Cancer and Its Risk Factors in a Korean Multicenter Study
- Authors
- Hwangbo, Yul; Kim, Jung Min; Park, Young Joo; Lee, Eun Kyung; Lee, You Jin; Park, Do Joon; Choi, Young Sik; Lee, Kang Dae; Sohn, Seo Young; Kim, S.W.; Chung, J.H.; Lim, D.J.; Kim, M.H.; Kim, M.J.; Jo, Y.S.; Shong, M.H.; Koong, S.-S.; Hahm, J.R.; Jung, J.H.; Yi, K.H.
- Issue Date
- Feb-2017
- Publisher
- ENDOCRINE SOC
- Citation
- JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, v.102, no.2, pp.625 - 633
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
- Volume
- 102
- Number
- 2
- Start Page
- 625
- End Page
- 633
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/152877
- DOI
- 10.1210/jc.2016-2287
- ISSN
- 0021-972X
- Abstract
- Context: Small papillary thyroid cancer (PTC) generally has an excellent prognosis. However, longterm recurrence is not uncommon and sometimes leads to morbidity or mortality. Objective: To identify high-risk factors for long-term recurrence in patients with small PTC by stratifying their pathologic characteristics. Design, Setting, and Patients: We conducted a nationwide, retrospective, multicenter study of 3282 patients with PTC sized ≤2 cm from 9 high-volume hospitals in Korea. Main Outcome Measures: The maximally selected x2 method was used to find the best cutoff points of tumor size, the number of metastatic lymph nodes (LNs), and the ratio of metastatic/examined LNs (LNR) to predict recurrence. Kaplan-Meier analysis and the Cox proportional hazards regression model were used to analyze recurrence and risk factors. Results: The optimal tumor size cutoff was 1.8 cm (10-year recurrence rates for tumors sized 0.1 to 1.7 cm and 1.8 to 2.0 cm: 7.7% vs 17.2%, respectively). Metastatic LNs ≤1 and ≥2 provided optimal estimates of recurrence (10-year recurrence rates: 4.0% vs 16.8%, respectively). The LNR of 0.19 was the optimal cutoff point for predicting the risk of recurrence (10-year recurrence rates for LNRs of 0 to 0.18 and 0.19 to 1: 2.7% vs 16.2%, respectively). LN metastasis, lobectomy, tumor size ≥1.8 cm, and bilateral tumors were independent risk factors for recurrence. Conclusions: Long-term recurrence was increased in patients who underwent lobectomy or with tumor sized ≥1.8 cm, 2 or more metastatic LNs, or bilateral tumors. For patients with these high-risk features, total thyroidectomy could be considered to avoid reoperation.
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