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Clinical significance of extrathyroidal extension to major vessels in papillary thyroid carcinoma

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Abstract

Purpose

Gross extrathyroidal extension (gETE) into major vessel is considered the most advanced stage of the locally advanced papillary thyroid cancer (PTC). Surgical intervention may not benefit some patients at this disease stage or even result in intraoperative death due to massive hemorrhage; however, it is still considered an effective strategy for most cases. The lack of description for this challenging invasion in PTC warrants detailed characterization of its pattern, risk factors, optimal surgical method, and prognostic value.

Methods

In total, 3127 patients diagnosed as having PTC were enrolled and categorized into two the following groups, namely the major vessel invasion (MVI) group (n = 30) and the control group (n = 3097). Data regarding clinicopathological and demographic characteristics, vascular invasion sites, postoperative complications, locoregional recurrence, distant metastasis, and surgical strategies were collected. Predictive disease-free survival (DFS) was also compared between the two groups.

Results

MVI was independently associated with invasion of the esophageal extension, age < 55 years, tumor size > 1 cm, lateral lymph node metastasis, and distant metastasis (P = 0.00; P = 0.01; 0.05; P = 0.00; P = 0.00, respectively). The difference in the predictive DFS between the two groups was significant (P = 0.00), and the difference remained significant even in patients with ETE when compared with patients without ETE (P = 0.00). Additionally, predictive DFS did not differ significantly between patients who received vessel repairment and those who received vessel resection (P = 0.28).

Conclusions

This study first characterized the gross MVI pattern exhibited by PTC and the risk factors for MVI. Additionally, it demonstrated the DFS of patients with PTC. Extensive gross MVI significantly worsened the biological characteristics of PTC. Regardless of the high risk and difficulty of the operation, patients still benefited from the surgical intervention, and vessel repairment may be the optimal surgical strategy.

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Acknowledgements

We thank director Jingqiang Zhu of Center of Thyroid and Parathyroid Surgery, West China Hospital for providing administrative support.

Funding

This work was supported by the Science and Technology Department in Sichuan province [2021YFS0103].

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Authors and Affiliations

  1. Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China

    M. Abuduwaili, A. Su, Z. Xing, B. Xia, Z. Wu, Y. Fei, J. Zhu & Z. Chen

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  1. M. Abuduwaili
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  2. A. Su
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  3. Z. Xing
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  4. B. Xia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MA, ZX, BX, CZ, ZW, JZ and AS. The first draft of the manuscript was written by MA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. Su.

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The authors have no competing interests to declare that are relevant to the content of this article.

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Ethical approval was waived by the local Ethics Committee of West China Hospital, Sichuan University, in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Abuduwaili, M., Su, A., Xing, Z. et al. Clinical significance of extrathyroidal extension to major vessels in papillary thyroid carcinoma. J Endocrinol Invest 46, 1155–1167 (2023). https://doi.org/10.1007/s40618-022-01966-5

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