Does the T1 subdivision correlate with the risk of recurrence of papillary thyroid cancer?

作者：Chereau Nathalie; Tresallet Christophe; Noullet Severine; Godiris Petit Gaelle; Tissier Frederique; Leenhardt Laurence; Menegaux Fabrice^*

来源：Langenbeck's Archives of Surgery, 2016, 401(2): 223-230.

DOI：10.1007/s00423-016-1399-y

• Thyroid cancer
• Papillary
• Recurrence
• Lymph node dissection
• Lymph nodemetastases
• Thyroidectomy

Background Based on the AJCC seventh TNM classification, T1 intraglandular tumors are subdivided into T1a (<= 10 mm) and T1b (11-20 mm), but the differences in prognosis remain controversial. The present study aimed to determine the clinicopathological features and outcomes of T1a and T1b patients.
Methods A retrospective study of 2518 T1 patients, including 1840 T1a (73 %) and 678 (27 %) T1b patients who underwent surgery for PTC from 1978 to 2014, was conducted. In patients with a preoperative or operative diagnosis of PTC, a total thyroidectomy (TT) with prophylactic (macroscopically N0) or therapeutic (evident N1) lymph node dissection (LND) was performed. Other patients had a TT or partial thyroidectomy without LND. The mean follow-up time was 8.9 +/- 8.8 years (median, 6.5 years; range, 1-36.4 years).
Results A TT was performed in 2273 patients (90 %), including 1184 (52 %) with LND. Other patients (n = 245) had a single lobectomy with isthmectomy. Multifocality, bilaterality, number of tumors, sum of the largest size of all foci, vascular invasion, and (in patients with LND) LN metastases were significantly more frequent in T1b than in T1a patients. Of the 1184 patients with LND, 278 had LN metastases (N1, 23 %), including 136/680 T1a (20 %) and 142/504 (28 %) T1b patients (p = 0.002). These LN metastases were diagnosed after a prophylactic LND in 86/609 T1a (14 %) and 93/440 T1b (21 %) patients (p = 0.001). Recurrences were more frequent in T1b (n = 26, 3.8 %) than in T1a patients (n = 35, 1.9 %, p = 0.005). In the multivariate analysis, independent prognostic factors for recurrence in both groups were the number of tumors, the sum of the largest size of all foci and, in patients who had LND, LN metastases and extranodal extension. For N0-x patients, the recurrence rate was significantly higher in the T1b than in the T1a group (2.4 vs. 0.9 %, respectively, p = 0.005), although this rate was similar in N1 patients (16.2 % for T1a and 9.2 % for T1b patients, p = 0.1). The 5-year disease-free survival rates for T1a and T1b patients were 98.3 and 96.6 %, respectively (p = 0.01).
Conclusions For PTC patients, T1b had poorer clinicopathological features and increased risk of recurrence than T1a.

• 出版日期2016-3