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Impact of microscopic extra‐nodal extension (ENE) on locoregional recurrence following curative surgery for papillary thyroid carcinoma
Author(s) -
Lang Brian H.H.,
Shek Tony W.H.,
Wan Koon Yat
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24180
Subject(s) - medicine , papillary carcinoma , surgery , thyroid carcinoma , nodal , carcinoma , general surgery , thyroid
Background The presence of microscopic extra‐nodal extension (ENE) may increase locoregional recurrence (LRR) in papillary thyroid carcinoma (PTC). We aimed to evaluate the association between microscopic ENE, response to initial therapy and LRR risk following total thyroidectomy, therapeutic neck dissection, and radioactive iodine (RAI) ablation in PTC. Methods Of the 369 eligible PTC patients, 264 (71.5%) did not have microscopic ENE (group I) while 105 (28.5%) did (group II). All presented with clinical nodal metastasis (cN1) and underwent therapeutic neck dissection and RAI ablation. Biochemical incompleteness meant post‐ablation stimulated thyroglobulin (sTg) >10 ng/ml. Multivariate analyses were conducted to identify independent factors for LRR. Results Biochemical incompleteness was significantly more common group II (43.8% vs. 17.4%, P < 0.05). The 10‐year locoregional free‐survival was significantly worse in group II than I (52.0% vs. 86.2%, P = 0.005). After adjusting for other significant factors, age <45 ( P < 0.05), multifocality ( P < 0.05), presence of ENE ( P = 0.027) were independent risk factors of LRR. The number and size of positive lymph nodes were not independent factors. Conclusions Patients with microscopic ENE were significantly more likely to have biochemical incompleteness after initial therapy. After adjusting for other significant primary and nodal characteristics, microscopic ENE was an independent factor for LRR in patients with cN1. J. Surg. Oncol. 2016;113:526–531 . © 2016 Wiley Periodicals, Inc.