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The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis.

Methods

This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event.

Results

The study enrolled 64 patients. Of these patients, 21 (32.8%) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3% in those with and 92.3% in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0% in those with and 29.3% in those without extensive ETE; p = 0.013).

Conclusions

Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Young Ki Lee MD, Daham Kim MD, PhD, Dong Yeob Shin MD, PhD & Eun Jig Lee MD, PhD

  2. Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea

    Young Ki Lee MD

  3. Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Cho Rok Lee MD, Sang-Wook Kang MD, PhD, Jandee Lee MD, PhD, Jong Ju Jeong MD, Kee-Hyun Nam MD, PhD, Woong Youn Chung MD, PhD & Cheong Soo Park MD, PhD

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  1. Young Ki Lee MD
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Correspondence to Dong Yeob Shin MD, PhD or Cho Rok Lee MD.

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Lee, Y.K., Kim, D., Shin, D.Y. et al. The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study. Ann Surg Oncol 26, 2200–2209 (2019). https://doi.org/10.1245/s10434-019-07314-x

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