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Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: is thyroid lobectomy the treatment of choice for low-risk patients?
Surgery. 2014 Dec; 156(6):1579-88; discussion 1588-9.S

Abstract

BACKGROUND

Our original system for risk group classification for predicting cause-specific death from papillary thyroid carcinoma (PTC) defined patients with distant metastasis and older patients (≥ 50 years) with either massive extrathyroidal extension or large (≥ 3 cm) lymph node metastasis as high risk; all others are low risk. For unilateral, low-risk PTC, the extent of thyroidectomy (less-than-total thyroidectomy vs total or near-total thyroidectomy) has been determined based on the choice of the patient since 2005.

PATIENTS

Of 1,187 patients who underwent initial thyroidectomy for PTC (tumor size [T] >1 cm) between 1993 and 2010, 967 (82%) were classified as low risk. Among low-risk patients, 791 (82%) underwent less than total thyroidectomy.

RESULTS

The 10-year cause-specific survival and disease-free survival rates did not differ between patients who underwent total thyroidectomy versus less than total thyroidectomy (cause-specific survival, 99% vs 99% [P = .61]; disease-free survival, 91% vs 87% [P = .90]). Age ≥ 60 years, T ≥ 3 cm, and lymph node metastases >3 cm represented significant risk factors for distant recurrence.

CONCLUSION

The favorable overall survival of low-risk patients, regardless of the extent of thyroidectomy, supports patient autonomy in treatment-related decision making. Low-risk patients possessing risk factors for distant recurrence would be likely to benefit from total thyroidectomy followed by radioactive iodine.

Authors+Show Affiliations

Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Endocrine Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan. Electronic address: isugitani@jfcr.or.jp.Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.Division of Ultrasonography Examination, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25262223

Citation

Ebina, Aya, et al. "Risk-adapted Management of Papillary Thyroid Carcinoma According to Our Own Risk Group Classification System: Is Thyroid Lobectomy the Treatment of Choice for Low-risk Patients?" Surgery, vol. 156, no. 6, 2014, pp. 1579-88; discussion 1588-9.
Ebina A, Sugitani I, Fujimoto Y, et al. Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: is thyroid lobectomy the treatment of choice for low-risk patients? Surgery. 2014;156(6):1579-88; discussion 1588-9.
Ebina, A., Sugitani, I., Fujimoto, Y., & Yamada, K. (2014). Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: is thyroid lobectomy the treatment of choice for low-risk patients? Surgery, 156(6), 1579-88; discussion 1588-9. https://doi.org/10.1016/j.surg.2014.08.060
Ebina A, et al. Risk-adapted Management of Papillary Thyroid Carcinoma According to Our Own Risk Group Classification System: Is Thyroid Lobectomy the Treatment of Choice for Low-risk Patients. Surgery. 2014;156(6):1579-88; discussion 1588-9. PubMed PMID: 25262223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: is thyroid lobectomy the treatment of choice for low-risk patients? AU - Ebina,Aya, AU - Sugitani,Iwao, AU - Fujimoto,Yoshihide, AU - Yamada,Keiko, Y1 - 2014/09/26/ PY - 2014/02/24/received PY - 2014/08/20/accepted PY - 2014/9/29/entrez PY - 2014/9/30/pubmed PY - 2015/2/19/medline SP - 1579-88; discussion 1588-9 JF - Surgery JO - Surgery VL - 156 IS - 6 N2 - BACKGROUND: Our original system for risk group classification for predicting cause-specific death from papillary thyroid carcinoma (PTC) defined patients with distant metastasis and older patients (≥ 50 years) with either massive extrathyroidal extension or large (≥ 3 cm) lymph node metastasis as high risk; all others are low risk. For unilateral, low-risk PTC, the extent of thyroidectomy (less-than-total thyroidectomy vs total or near-total thyroidectomy) has been determined based on the choice of the patient since 2005. PATIENTS: Of 1,187 patients who underwent initial thyroidectomy for PTC (tumor size [T] >1 cm) between 1993 and 2010, 967 (82%) were classified as low risk. Among low-risk patients, 791 (82%) underwent less than total thyroidectomy. RESULTS: The 10-year cause-specific survival and disease-free survival rates did not differ between patients who underwent total thyroidectomy versus less than total thyroidectomy (cause-specific survival, 99% vs 99% [P = .61]; disease-free survival, 91% vs 87% [P = .90]). Age ≥ 60 years, T ≥ 3 cm, and lymph node metastases >3 cm represented significant risk factors for distant recurrence. CONCLUSION: The favorable overall survival of low-risk patients, regardless of the extent of thyroidectomy, supports patient autonomy in treatment-related decision making. Low-risk patients possessing risk factors for distant recurrence would be likely to benefit from total thyroidectomy followed by radioactive iodine. SN - 1532-7361 UR - https://www.unboundmedicine.com/medline/citation/25262223/Risk_adapted_management_of_papillary_thyroid_carcinoma_according_to_our_own_risk_group_classification_system:_is_thyroid_lobectomy_the_treatment_of_choice_for_low_risk_patients L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(14)00538-8 DB - PRIME DP - Unbound Medicine ER -