Open AccessRecurrence following hemithyroidectomy in patients with low‐ and intermediate‐risk papillary thyroid carcinoma
Author(s) -
Ahn D.,
Lee G. J.,
Sohn J. H.
Publication year - 2020
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11430
Subject(s) - medicine , thyroid carcinoma , hazard ratio , thyroid , thyroid cancer , carcinoma , risk factor , thyroidectomy , population , retrospective cohort study , incidence (geometry) , surgery , confidence interval , physics , environmental health , optics
Background This study evaluated the incidence, patterns and risk factors for recurrence after hemithyroidectomy in patients with low‐ and intermediate‐risk papillary thyroid carcinoma (PTC), and verified the predictive role of the risk staging systems in current use. Methods The clinicopathological characteristics and risk categories were analysed according to recurrence in patients who underwent hemithyroidectomy for low‐ and intermediate‐risk conventional PTC, and were followed up for at least 24 months. Five risk staging systems were used to stratify risk: the 2015 American Thyroid Association (ATA) system; Age, Metastases, Extent and Size (AMES) system; Metastases, Age, Complete resection, Invasion and Size (MACIS) system; Grade, Age, Metastases, Extent and Size (GAMES) system; and the eighth AJCC system. Results The study included 561 patients; 93·9 per cent of the study population (527 of 561) had a papillary thyroid microcarcinoma 1 cm or smaller in size. At a mean follow‐up of 83 months, 25 patients (4·5 per cent) had recurrence; among these patients, 23 (92%) presented with a remaining thyroid lobe. Multifocality was significantly associated with recurrence in univariable and multivariable analyses (adjusted hazard ratio 3·16, 95 per cent c.i. 1·25 to 7·98; P = 0·015). Disease‐free survival (DFS) varied according to multifocality ( P = 0·010). The five risk staging systems were not associated with recurrence, and their Harrell's C‐index ranged from 0·500 to 0·531. DFS rates did not differ between the risk categories in each system. Conclusion Although the recurrence rate after hemithyroidectomy in patients with low‐ and intermediate‐risk PTC was low, meticulous follow‐up focusing on the remaining thyroid lobe is needed for early detection and timely management of recurrence. The risk scoring systems in current use have no predictive role in these patients.