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Papillary Thyroid Microcarcinoma : A Report of Impact of Initial Therapy in 2035 Patients. Jeonghun Lee, Su Han Seo , Euy Young Soh Department of Surgery, Ajou University. Introduction. Introduction Papillary thyroid carcinoma ① accounts for up to 80% of thyroid cancer

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Papillary thyroid microcarcinoma a report of impact of initial therapy in 2035 patients

Papillary Thyroid Microcarcinoma: A Report of Impact of Initial Therapy in 2035 Patients

Jeonghun Lee, Su Han Seo,

Euy Young Soh

Department of Surgery, Ajou University


Introduction
Introduction

Introduction

Papillary thyroid carcinoma

① accounts for up to 80% of thyroid cancer

② papillary microcarcinoma : 36~60% of papillary thyroid cancer

Discrepancy of treatment strategies

① geographical discrepancy

: Western vs. Japan

a. total thyroidectomy vs. lobectomy

b. therapeutic vs. prophylactic CCND

c. radioiodine therapy

② temporal discrepancy

: at Mayo Clinic (Hay et al)

a. 1940~54 - most lobectomy and no RAI

b. 1985~ - most total thyroidectomy and 50% RAI therapy


Introduction1
Introduction

Prognostic factors for recurrence

- different among the institutions

  • Buffet et al ( Europ J endo 2012 )

    : LN metastasis, multifocality, male, total size of multifocal tumor>20mm)

  • Kim TY et al ( BMC cancer 2008 )

    : male, lateral cervical LN metastasis

  • Chow et al ( Cancer 2003 )

    : multifocality, limited surgery

  • Hay et al ( Surgery 1992 )

    : LN metastasis, limited surgery


Purpose
Purpose

: To investigate the prognostic factors for recurrence in PTMC patients.


Materials and methods
Materials and Methods

Periods : Jan.1994 ~ Oct. 2010

Patients : 2035 PTMC patients who underwent thyroidectomy at Ajou University Hospital

Inclusion criteria

① papillary thyroid microcarcinoma

② underwent primary surgical therapy at Ajou University Hospital


Materials and methods1
Materials and Methods

  • Strategy for papillary thyroid cancer at Ajou University Hospital

    ① Lobectomy

    : papillary thyroid caner < 1cm, no familial history,

    no capsular invasion, no multifocality and no LN metastasis.

    ② Central compartment LN dissection(CCND)

    : if malignancy on FNA cytology or frozen section biopsy

     prophylactic CCND was performed

    ③ Lateral compartment LN dissection

    : therapeutic LN dissection


Materials and methods2
Materials and Methods

  • Mean follow-up duration : 33.8 months

WIFTC : wide invasive FTC, MIFTC : minimal invasive FTC

MTC : medullary thyroid cancer, HCC : Hurthle cell cancer



Univariate statistical analysis for recurrence
Univariate statistical analysis for recurrence


Univariate statistical analysis for recurrence1
Univariate statistical analysis for recurrence


Univariate statistical analysis for recurrence2
Univariate statistical analysis for recurrence

RAI therapy

97.9%

74.3%


Univariate statistical analysis for recurrence3
Univariate statistical analysis for recurrence

N stage

98.1%

92.6%

90.5%

67.3%



Summary
Summary

  • Prognostic factors for recurrence

    ① Extent of thyroidectomy : no significant factor

    ② RAI therapy : no significant factor in multivariate analysis

    ③ N stage : only significant factor for recurrence in multivariate analysis

    - N1a : 2 riskier than N0 ( p= 0.01)

    - N1b : 6.7 riskier than N0 (p< 0.01)

  • Complication

    ① postoperative hoarseness : 1.9%

    ② permanent hypoparathyroidism : 4.5% (2.7%*~12%#)

*Caliskan et al 2012 Endocrine J

#Mitra et al 2011 J LaryngolOtol


Conclusion
Conclusion

  • Limited thyroidectomy

    : maybe sufficient for initial surgery for PTMC patients

  • Prophylactic central LN dissection

    : can be performed for PTMC patients for predicting prognosis accurately,

    : however, performed by skilled surgeon because of higher incidence of permanent hypoparathyroidism

  • Limitation of study

    : short-term follow-up duration


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