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Open Access
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(04): e585-e593
DOI: 10.1055/s-0040-1722253
Original Research

Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients

Autoren

  • Andre de Ywata Carvalho 

    1   Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil

  • Hugo Fontan Kohler 

    1   Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil

  • Camila Couto Gomes 

    2   Surgical Oncology Division, A. C. Camargo Cancer Center, São Paulo, Brazil

  • José Guilherme Vartanian 

    1   Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil

  • Luiz Paulo Kowalski 

    1   Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
    3   Head and Neck Surgery Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Abstract

Introduction The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial.

Objective To identify the clinical and pathological factors predictive of tumor recurrence.

Methods We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the American Thyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence.

Results After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (p = 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (p = 0.032; HR: 1.76; 95%CI: 1.05 to 2.96), and the presence of lymph-node metastasis (p < 0.001; HR: 3.69; 95%CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients.

Conclusions The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age < 55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.

Keywords

thyroid - papillary microcarcinoma - recurrence - prognosis - risk stratification


Publikationsverlauf

Eingereicht: 15. Juni 2020

Angenommen: 16. November 2020

Artikel online veröffentlicht:
19. Februar 2021

© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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