The treatment of well-differentiated thyroid cancer

The management of well differentiated thyroid cancer continues to generate considerable debate and controversy regarding diagnostic evaluation, extent of surgery, and postoperative adjuvant therapy and follow-up. The fine-needle aspiration biopsy has been routinely used for diagnostic evaluation of thyroid nodule. Understanding prognostic factors and risk group analysis is extremely crucial in the overall management of thyroid cancer regarding the extent of thyroidectomy and adjuvant therapy. Patients in the low-risk group do extremely well and can be treated with lobectomy alone while those in the high-risk group invariably require total thyroidectomy due to the need of adjuvant radioactive iodine treatment. Thyroglobulin appears to be a good tumor marker in patients who have undergone total thyroidectomy during follow-up. One of the major nuances in the management of thyroid cancer is the availability of recombinant TSH which can be used for radioactive iodine dosimetry during the follow-up of patients with well differentiated thyroid cancer. This prevents patients from becoming hypothyroid for an extended period of time which directly affects their quality of life. Understanding poorly differentiated thyroid cancer is extremely crucial as an important histologic prognostic factor and generally being nonradioavid tumors. PET scan is useful in the follow-up of these patients to evaluate the extent of distant metastasis.     

分化型甲状腺癌危险组的划分及其意义

目的探讨分化型甲状腺癌各危险组的划分及其与治疗和预后的关系。方法回顾分析514例分化型甲状腺癌患者,借助于单和多变量分析确定有意义的预后因素,再根据这些因素将患者分成低、中和高三个危险组。应用Kaplan-Meier方法计算出各危险组患者以及各预后因素所表现出来的生存曲线。结果长期生存率在低、中和高危组分别为98．3%、83．6%和42．9%。在低危组和部分选择出来的中危组患者仅做腺叶及峡部切除,而在高危组及部分选择的中危组患者则做较广范围切除,术后再辅以内或外放射治疗。结论将分化型甲状腺癌分成三个危险组并借以制订治疗措施和判断预后是十分正确的。     

Recurrence pattern after conservative surgery for papillary thyroid carcinoma

Objective

Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma.

Methods

We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk.

Results

The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p < 0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (≥4 cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis.

Conclusion

Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence.     

Total versus subtotal thyroidectomy. Arguments, approaches, and recommendations

Arguments for routine total thyroidectomy or routine, less than total resection have been espoused for treatment of well-differentiated intrathyroidal carcinoma. Numerous reports in the literature support either approach. No prospective randomized studies have been performed, partly because of the indolent nature of the disease. Many reports are also complicated by the failure of the authors to divide patients into high-risk and low-risk groups and to categorize and evaluate fully the histologic types of the resected tumors. Good evidence exists to show that in the majority of cases of intrathyroidal, well-differentiated lesions, bilateral subtotal resection yields results that compare favorably with total thyroidectomy. Logically, at least, a total thyroidectomy would seem to be preferable, because subtotal resection can be imprecise. Therefore, subtotal thyroidectomy can be recommended over total thyroidectomy, if only on the basis of comparison of complications. The type and rate of complications vary among surgeons. Each thyroid surgeon, therefore, must establish an individual complication rate. Total thyroidectomy in inexperienced hands is not recommended. We recommend, therefore, that total thyroidectomy be used selectively by surgeons who have the skill and experience necessary to make the decision intraoperatively. If, for example, during resection of the lobe that contains the primary tumor, the laryngeal nerves and parathyroid glands can be clearly identified and if there is minimal bleeding and trauma, the surgeon may proceed to side two to perform a total thyroidectomy. If the lesion is large, however, with distortion of anatomy, dissection may be difficult even for an experienced surgeon. Intracapsular parathyroids or undiscovered parathyroids on the side of initial resection should prompt the surgeon to perform a subtotal resection on side two. Under these circumstances, the surgeon should not feel that a total thyroidectomy justifies the increased risk. A unilateral resection, such as lobectomy plus isthmusectomy, can be performed with satisfactory long-term results in low-risk patients, that is, in those with small (less than 1.5 cm) unilateral intrathyroidal exposure and in those with no evidence of metastatic disease. Alternately, the AGES criteria of Hay et al can be used to identify patients in low- or high-risk groups. If the decision to perform a bilateral resection is based on the previous criteria, we recommend that a total thyroidectomy be performed only by an experienced surgeon. During surgery, if there is any suggestion that the laryngeal nerves or parathyroid glands would be at increased risk if a total resection were performed, it may be necessary to revert to a subtotal procedure.(ABSTRACT TRUNCATED AT 400 WORDS)     

Distant metastases from thyroid and parathyroid cancer.

Thyroid cancer represents a unique biological tumor where even with the high incidence of distant metastases, the overall prognosis is not as poor as many other human cancers. The overall long-term survival in patients presenting initially with distant metastasis is approximately 50%. The overall incidence of distant metastases varies between 10 and 35%, depending upon the histology. The overall incidence is directly related to various histologies - being least in papillary thyroid carcinoma (10%) and highest in Hürthle cell tumor (33%). The incidence of distant metastases is also very high in patients with medullary and anaplastic thyroid cancer. The incidence of distant metastases at the time of initial presentation in differentiated thyroid cancer is approximately 4%. In high-risk patients - especially in patients with extrathyroidal extension or massive nodal metastasis - the distant metastases can be evaluated after total thyroidectomy with radioactive iodine ablation. Pulmonary metastases are very common in young individuals, but they are extremely well treated and the mortality from distant metastases in this group is very low. However, distant metastases in patients with poorly-differentiated carcinoma have a poor prognosis. In high-risk patients, generally a total thyroidectomy should be undertaken so that the patient can undergo radioactive iodine dosimetry and ablation as indicated. The surveillance in patients with thyroid cancer includes: close clinical follow-up, chest X-ray, and radioactive iodine dosimetry. Thyroglobulin is commonly used as a prognostic marker in patients having undergone total thyroidectomy. The incidence of distant metastases in medullary thyroid cancer is high, mainly to the lung and liver. Persistent hypercalcitonemia is an indication of regional or distant metastases. A variety of diagnostic tests are helpful, such as octreotide scanning, computed tomography scan, magnetic resonance imaging and positron emission tomography scan. Laparoscopy to evaluate the surface of the liver is also an important investigation to detect distant metastases. The incidence of distant metastases is very high in patients with anaplastic thyroid cancer, but most of the time the outcome depends on the locoregional recurrence and massive disease in the central compartment. The parathyroid cancer is quite rare, less than 1%, in patients undergoing parathyroidectomy. The diagnosis of parathyroid cancer is made by pathological features but the most certain method of diagnosis of a malignant tumor of the parathyroid is the identification of secondary deposits. The incidence of distant metastasis is difficult to determine due to the rarity of this condition, but the most common site is the lung. Patients with distant metastasis have recurrent progressive hypercalcemia along with high parathormone level.     

Total thyroidectomy is the recommended treatment for all Papillary Thyroid Carcinoma (PTC)

Surgical treatment of well differentiated carcinomas of the thyroid gland remains a discussed topic and there is still no evidence of global and total harmony in the appropriate surgical procedure to be applied in the approach of these tumors. The major unresolved debate concerning the ideal surgical management of PTC focuses on the extent of thyroidectomy. The most common recommended options range from thyroid lobectomy to a total extracapsular thyroidectomy. Controversy concern not only the extent of thyroidectomy but also the indications for, and the extent of cervical lymph node dissection. To date, there are no controlled prospective trials comparing the results of different surgical treatments of PTC. There are, however, several large retrospective reports that have addressed the extent of thyroidectomy in the management of patients with PCT1. The purpose of this review article is to demonstrate that total thyroidectomy seems to be the optimal treatment for most patients with clinically significant PTC. We also emphasize that the ability to perform thyroid surgery safely is of paramount importance with an excellent long-term prognosis. To determine the ideal treatment surgeons must weigh the risk-complications of a more aggressive surgical resection (total thyroidectomy) versus the risk of morbidity, mortality, recurrence rates and difficulty in following patients who undergo less gland resection (lobectomy). It is mandatory to expand efforts to identify high-risk patients more accurately, thereby facilating more rational approaches to treatment.     

Cost-effective management of low-risk papillary thyroid carcinoma

OBJECTIVE: To compare the 20-year cost-effectiveness of initial hemithyroidectomy vs total thyroidectomy in the management of small papillary thyroid cancer in the low-risk patient. DESIGN: Pooled data from the published literature were used to determine key statistics for decision analysis such as rates of recurrence, rates of complications for all interventions undertaken, and rates of death. The 2005 costs were obtained from the US Department of Health and Human Services, as well as from Medicare reimbursement schedules. Future costs were discounted at 6%. SETTING: Decision analysis study. PATIENTS: Data from the published literature. MAIN OUTCOME MEASURES: A state-transition (Markov) decision model was constructed based on the most recent American Thyroid Association recommendations. A cost-effectiveness analysis was performed using fixed probability estimates and Monte Carlo microsimulation, with effectiveness defined as cause-specific mortality or recurrence-free survival. After identifying initial results, sensitivity and threshold analyses were performed to assess the strength of the recommendations. RESULTS: Initial probability estimates were determined from a review of 940 abstracts and 31 relevant studies examining outcomes in patients with low-risk thyroid cancer undergoing thyroidectomy or neck dissection. During 20 years, cost estimates (including initial surgery, follow-up, and treatment of recurrence) were between $13,896.81 and $14,241.24 for total thyroidectomy and between $15,037.58 and $15,063.75 for hemithyroidectomy. Cause-specific mortality was similar for both treatment strategies, but recurrence-free survival was higher in the total thyroidectomy group. Sensitivity and threshold analyses demonstrated that these results were sensitive to rates of recurrence and cost of follow-up but remained robust when compared with willingness to pay. CONCLUSIONS: Total thyroidectomy dominates over hemithyroidectomy as initial treatment for low-risk papillary thyroid cancer. However, in sensitivity analyses, these results varied by institution because of heterogeneity in long-term treatment outcomes. With changing protocols of management, it is possible that hemithyroidectomy will emerge as being more cost-effective. Long-term prospective trials are necessary to validate our findings.     

The treatment of differentiated carcinoma of the thyroid gland. Selective management?

Two hundred thirty patients with differentiated carcinoma of the thyroid gland received definitive treatment at the University of Texas M. D. Anderson Hospital and Tumor Institute (MDAH), Houston, from January 1960 through December 1975. Two thirds of these patients were women, and 127 of these female patients (55%) had not had any previous treatment. The mean follow-up period was 11.8 years. The vast majority of patients (80%) had mixed papillary and follicular cancers; 104 patients were seen with cervical metastases. Overall absolute survival was 72.6%. The prognosis was more favorable in the female patients and those persons who were treated solely at MDAH. In 4.4% of those patients treated with a total thyroidectomy, the cancer recurred locally. Of those whose operation was only a lobectomy, local recurrence developed in 10.7%. Several adverse prognostic factors were identified in this group of patients. This analysis would suggest the need for a more selective approach to the surgical treatment of this disease. Differentiated cancer of the thyroid gland affects a heterogeneous group of patients and also appears with varied clinical and anatomic manifestations.     

‘Aggressive papillary’ thyroid microcarcinoma

The objective of this study is to highlight the fact that papillary thyroid microcarcinoma can be aggressive, requiring therapeutic management similar to that of other differentiated thyroid cancers. This 8-year retrospective study concerned 187 surgical patients managed in an ENT and Head and Neck surgery department for thyroid cancer. 65 patients were found to have papillary microcarcinoma. 41 microcarcinomas were considered to be aggressive because of the presence of several risk factors such as larger than 5 mm, multifocal microcarcinomas, capsular effraction, vascular embolus, tumour extension beyond the thyroid parenchyma and metastatic lymphadenopathy. All patients with aggressive papillary microcarcinoma were treated by total thyroidectomy and ¹³¹I. Ipsilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in ten patients, ipsilateral cervical lymph node dissection was performed in six patients and bilateral recurrent laryngeal and lateral cervical lymph node dissections were performed in three patients. No recurrence or metastasis was observed (follow-up ranging from 6 months to 8 years). The optimal management of thyroid papillary microcarcinoma is still controversial. “Aggressive” papillary thyroid microcarcinoma is not rare and may justify aggressive treatment depending on the presence or absence of prognostic risk factors.     

儿童分化型甲状腺癌的临床特征及危险因素分析

目的 近年来,儿童甲状腺癌发病率不断上升,因此探讨儿童分化型甲状腺癌(children differentiated thyroid cancer,DTC)的临床特征并分析复发病例情况。 方法 回顾性分析1998年1月~2018年5月在上海交通大学医学院附属新华医院就诊的年龄≤13岁的50例儿童分化型甲状腺癌的临床资料。以7岁为界分为学龄前期组(≤7周岁)和学龄期组(>7周岁至13周岁),比较学龄前期与学龄期的临床特征情况。根据儿童DTC复发与否进行分组,比较复发组与无复发组的临床特征数据。比较临床特征、TNM分期及AJCC推荐的风险水平、复发及转移情况。采用Kaplan-Meier评价各年龄组无复发生存率。 结果 50例中,学龄前期与学龄期在局部侵犯情况有显著统计学差异(P=0.008),学龄前期组的局部侵犯比例(6例,42.6%)高于学龄期组(3例,8.1%)。两组肿瘤T分期存在明显差异(χ2=12.584,P=0.028),学龄期组T2比例较高(19例,51.4%),而学龄前期组T4a比例较高(5例,38.5%)。手术并发症比例,学龄前期组显著多与学龄期儿童(χ2=9.632,P=0.008)。无发复组双侧甲状腺全切比例明显高于复发组(85.7%,53.3%)(χ2=11.227,P=0.004),甲状腺全切可以降低儿童DTC复发风险。复发组与无复发组TNM与风险水平无统计学差异。复发组T1a、T1b和T2的总百分比超过50%,低风险水平为37.5%,中风险水平25%。约半数的复发病例在最初诊断时是TNM分期较低的且为低风险水平的。儿童DTC术后复发率差异无统计学意义(P>0.05)。 结论 学龄前期DTC病例的局部浸润,肿瘤分期以及手术并发症比例高于学龄期,年龄是儿童DTC的重要危险因素。将近一半的复发病例在最初诊断时是低风险的,因此应进一步研究儿童DTC复发风险评估策略。应提高对儿童DTC病例临床特征了解并采取适当的治疗策略。     

Postoperative complications of thyroidectomy for differentiated thyroid carcinoma

OBJECTIVE: This study evaluates the incidence and risk factors of complications in patients submitted to thyroidectomy for differentiated thyroid carcinoma in a cancer hospital with residency training. STUDY DESIGN: A retrospective chart and complications review of 316 consecutive patients who underwent thyroidectomy for differentiated thyroid carcinoma. RESULTS: Of the 316 patients, the main postoperative complications were transient hypocalcemia in 87 (27.5%), permanent hypocalcemia in 16 (5.1%), transient vocal cord palsy in 4 (1.2%), and permanent vocal cord palsy in 2 (0.6%). Neck dissection and paratracheal lymph node dissection when associated with total thyroidectomy were significantly related to transitory and permanent hypocalcemia. CONCLUSION: Thyroid surgery can be performed safely in a hospital with medical residency training program under direct supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant complication. Neck and paratracheal lymph node dissections were the most significant predictors of hypocalcemia in patients submitted to total thyroidectomy.     

The difficult tracheostomy simplified

Arguments for routine total thyroidectomy or routine, less-than-total resection have been espoused for treatment of well-differentiated intrathyroidal carcinoma. Numerous reports in the literature support either approach. No prospective randomized studies have been performed, partly because of the indolent nature of the disease. Many reports are also complicated by the failure of the authors to divide patients into high-risk and low-risk groups and to categorize and evaluate fully the histologic types of the resected tumors.Good evidence exists to show that in the majority of cases of intrathyroidal, well-differentiated lesions, bilateral subtotal resection yields results that compare favorably with total thyroidectomy. Logically, at least, a total thyroidectomy would seem to be preferable because subtotal resection can be imprecise. Therefore, subtotal thyroidectomy can be recommended over total thyroidectomy, if only on the basis of comparison of complications. The type and rate of complications vary among surgeons. Each thyroid surgeon, therefore, must establish an individual complication rate. Total thyroidectomy in inexperienced hands is not recommended.We recommend, therefore, that total thyroidectomy be used selectively by surgeons who have the skill and experience necessary to make the decision intraoperatively. If, for example, during resection of the lobe that contains the primary tumor, the laryngeal nerves and parathyroid glands can be clearly identified and if there is minimal bleeding and trauma, the surgeon may proceed to side two to perform a total thyroidectomy. If the lesion is large, however, with distortion of anatomy, dissection may be difficult even for an experienced surgeon. Intracapsular parathyroids or undiscovered parathyroids on the side of initial resection should prompt the surgeon to perform a subtotal resection on side two. Under these circumstances, the surgeon should not feel that a total thyroidectomy justifies the increased risk. A unilateral resection, such as lobectomy plus isthmusectomy, can be performed with satisfactory long-term results in low-risk patients—that is, in those with small (less than 1.5 cm) unilateral intrathyroidal exposure and in those with no evidence of metastatic disease. Alternately, the AGES criteria of Hay et al²⁹ can be used to identify patients in low-or high-risk groups.If the decision to perform a bilateral resection is based on the previous criteria, we recommend that a total thyroidectomy be performed by an experienced surgeon only. During surgery, if there is any suggestion that the laryngeal nerves or parathyroid glands would be at increased risk if a total resection were performed, it may be necessary to revert to a subtotal procedure. This situation, and others like it, requires a level of judicious intraoperative surgical decision-making that comes only with experience.     

Metachronous second primary tumours in the aerodigestive tract in patients with early stage head and neck squamous cell carcinomas

Early-stage head and neck carcinomas can usually be controlled with the appropriate treatment. In these patients, the long-term prognosis mainly depends on second metachronous malignancies, frequently in the aerodigestive tract. Our study aims to identify risk factors for the appearance of second tumours in this group of patients with early head and neck cancer. Of 949 patients included in the study, 189 (20%) developed a metachronous second primary malignancy, most frequently in the aerodigestive tract. Independent risk factors associated with second tumours were heavy alcohol use and the location of the index tumour in the oropharynx. Compared to non-drinkers, heavy drinkers (>80 g/day) presented a 1.8-times higher risk of a second tumour (CI 95%: 1.01–3.50). Patients with oropharyngeal tumours had a 2.15-higher risk than patients with oral cavity tumours (CI 95%: 1.03–4.47). Recursive partitioning analysis was used to characterise two risk groups for second tumours. The low-risk group included patients over 75 years and patients with low levels of carcinogen use. It comprised 171 patients (18%) with a 5.3% frequency of second tumours. The high-risk group accounted for 80% of the patients ( n =778), and the rate of second neoplasms was 16.3%. Classification of the patients according to the mentioned variables allows us to focus follow-up and prevention efforts on high-risk patients.     

免疫相关基因预后模型的构建对喉癌患者预后的影响[论著]

【摘要】 目的　探讨基于生物信息学方法构建免疫相关基因（immune-related genes,IRG）预后模型以准确预测喉癌患者的预后。方法　从癌症基因组图谱（the Cancer Genome Atlas,TCGA）数据库获得111个喉癌组织和12个正常相邻组织之间的差异表达基因（differentially expressed genes,DEG）。利用ImmPort数据库识别出差异表达的IRG。Cox单变量生存分析用于筛选与生存相关的IRG。差异表达的与生存相关的IRG被认为是预后相关的免疫基因。然后构建免疫基因预后模型计算患者风险值,受试者ROC曲线分析验证模型准确性。通过该模型行单因素、多因素独立预后分析证明其独立预测能力。最后分析关键免疫基因与临床病理参数的关联。结果　鉴定喉癌的DEG并筛选出IRG。接着与预后生存时间结合,鉴定8个关键免疫基因（CXCL11、RBP1、AQP9、CYSLTR2、BTC、STC2、UCN和FCGR3B）作为免疫基因预后模型,这种预后模型可以准确的将患者分为高危和低危人群。总体生存分析表明,高危患者的生存时间比低危患者要短（P <0.0001）。模型的ROC曲线下面积为0.810,提示预后模型具有较高的敏感性和准确性。单因素和多因素Cox回归表明其为喉癌患者预后的独立预测因素。此外,我们发现模型中的5个关键基因与临床病理特征显著相关。结论　基于生物信息学方法构建喉癌的免疫相关基因预后模型,发现8个基因有助于预测喉癌患者的预后,其中5个与临床病理特征显著相关。     

Prognosticators of survival in differentiated thyroid carcinoma

Differentiated carcinoma of the thyroid has good prognosis, even in patients presenting in the late stage and with distant metastasis. In India, the incidence of papillary carcinoma and follicular carcinoma are in the ratio of 60∶40. A retrospective study was carried out to determine the impact of patient and tumor factors on survival, and to develop a simple rish group staging system to predict survival in patients with differentiated thyroid carcinomas. Four hundred and seventeen (417) patients undergoing primary treatment at our hospital between 197–1985, were entered to the study. There were 198 follicular carcinomas and 219 papillary carcinomas. Impact of patient and tumor variables were studied by drawing Kaplan Meier curves and comparing them by the Chi Sq Test. Age<=40 years (p=0.00001), tumor size <5cms (p=0.01), extrrathyroidal spread (p=0.001) and distant metastasis (p=0.00001) had significant impact on survival. These finding were true for a subset analysis follicular and papillary carcinomas separately. A Cox Regression Analysis was also performed and this showed the above factors to impact significantly on survival. Basing on the regression analysis we devised a simple risk group system and classified the patients as high and low risk. Low risk group patients had a significant survival advantage. Our findings show that the incidence of follicular carcinoma is significantly high in india (48%) and that 65% of our patients are in the high risk group. Incidence of contralateral lobe disease on completion thyroidectomy is as high as 53%. Hence, a more aggressive treatment policy is warranted and total thyroidectomy is the appropriate treatment of choice in our patients.     

Quality of life in patients undergoing thyroid surgery

OBJECTIVE: The extent of thyroidectomy in the management of low-risk, well-differentiated thyroid carcinoma (WDTC) has been debated extensively. Our objective was to determine if hemithyroidectomy has a less detrimental effect on quality of life (QOL) than total thyroidectomy. DESIGN: Prospective, nonblinded, nonrandomized, cohort study. SETTING: Tertiary care academic otolaryngology-head and neck surgery practice. METHODS: Using both disease-specific and global QOL instruments, patients treated with either hemi- or total thyroidectomy were prospectively followed. QOL was assessed preoperatively and for 12 months postoperatively. MAIN OUTCOME MEASURES: Scores on the two QOL instruments throughout a 12-month postoperative period. RESULTS: Patients with cancer experienced a greater drop in QOL during the first 6 months following surgery when compared with patients with benign disease (p < .03). Additionally, patients treated with total thyroidectomy did not have a significantly different QOL than patients treated with hemithyroidectomy (p > .2). CONCLUSION: These results suggest that QOL is not significantly impacted by the extent of surgery and that QOL should not be a factor in the decision-making process for the treatment of low-risk WDTC.     

弗明汉危险评分与突发性聋听力预后的相关性

目的 探讨弗明汉危险评分(Framingham risk score)与突发性聋(突聋)患者听力预后的相关性.方法 以2018年1月至2020年1月住院治疗的242例突聋患者为研究对象,利用弗明汉危险评分公式评估其心血管危险因素并计算弗明汉危险评分积分值,评估患者未来10年冠心病的发病风险,并根据发病风险大小将研究对象...     

Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma

Objective.The risk-benefit ratio of central neck dissection (CND) in patients affected by papillary thyroid carcinoma (PTC) without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0) is currently debated. The aim of this study was to evaluate long-term outcome of CND on locoregional recurrence, distant metastasis, survival, and postoperative complications in a large series of patients with cN0-PTC.Study Design.Observational retrospective controlled study.

Clinical significance of residual occult malignancy in thyroid carcinoma

Purpose

Total or near-total thyroidectomy is advocated in reducing the recurrence rate and improving survival in differentiated thyroid carcinoma. However, this potential benefit could be seen in all patient groups or only in the patients who have multifocal disease. We analyzed the clinical significance of occult multifocal disease in patients with completion thyroidectomy.

Patients and methods

Ninety-seven patients in whom the completion thyroidectomy was performed within 6 months were included. The patients were grouped according to whether they have malignancy in the remnant thyroid tissue. The groups were examined and compared according to patients and tumor characteristics. The effect of the presence of residual tumor in remnant thyroid tissue on clinical course, disease-free survival, and overall survival were evaluated as well.

Results

After completion thyroidectomy, 20 (20.6%) of the 97 patients revealed additional cancer focus in the residual tissue. Median follow-up period was 104 months (range, 84-205 months). Only tumor multifocality in the resected lobe after first surgery was predictive of the presence of malignancy in the thyroid remnant (P = .002; relative risk, 4.9; 95% confidence interval, 1.7-14.5). Detection of malignancy in the remnant thyroid tissue did not affect the disease-free survival (P = .39). There were no deaths in patients who underwent reoperative thyroid surgery.

Conclusions

Only tumor multifocality in the original thyroid lobe was predictive of finding additional cancer in the contralateral lobe. However, clinical significance of occult multifocal disease was not shown.     

Management of compression symptoms of thyroid goiters: Hemithyroidectomy is equally as successful as total thyroidectomy

PurposePatients with thyroid goiters and compressive symptoms are treated with surgery. The adequate extent of this surgery for these cases remains unclear. In the current study, we analyze the effect of surgery, total thyroidectomy versus hemithyroidectomy, on the resolution of various compressive symptoms.Materials and methodsThis retrospective analysis utilized the TriNetX Research Network to recognize adults with thyroid goiters treated surgically. International Classification of Diseases 10 (ICD10) was used to identify patients. Two groups were created based on surgical treatment, for either a hemithyroidectomy or total thyroidectomy. The primary outcomes were compression symptoms, including dysphagia, choking/globus sensation, dyspnea, cough, and hoarseness/dysphonia.ResultsThis retrospective review included 45,539 subjects. Of these, 9293 had a partial thyroidectomy, and 36,246 had a total thyroidectomy. After propensity score matching was done for compression symptoms before surgery, there were 8280 patients in each group. There were no differences in symptoms between the matched groups, except for increased hoarseness and dysphonia after total thyroidectomy (RR, 95 % CI) (0.781, 0.67–0.91). Compression symptoms significantly decreased after surgical treatment in both the hemithyroidectomy and total thyroidectomy groups.ConclusionsHemithyroidectomy is associated with efficacy similar to total thyroidectomy in reducing compression symptoms postoperatively. Hemithyroidectomy may be able to alleviate compressive symptoms with less surgical risk.