Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Am J Surg. 2020 Sep;220(3):642-647. doi: 10.1016/j.amjsurg.2020.01.049. Epub 2020 Jan 30.
Papillary thyroid carcinoma (PTC) is generally associated with favorable outcomes; however, intermediate-risk requires further evaluation. We therefore examined risk factors for posttreatment recurrence in patients with intermediate-risk PTC.
This study involved 1782 patients who underwent thyroidectomy for intermediate-risk PTC. Univariate and multivariate Cox proportional hazard regression analyses were used to identify the significant factors predictive of posttreatment recurrence-free survival (RFS).
Of intermediate-risk factors, univariate analyses showed that clinical and pathological cervical lymph node (LN) positivity (cN1 and pN1), aggressive histology, and multifocality with microscopic extrathyroidal extension were significantly associated with RFS outcomes (all P < 0.05). In multivariate analyses, cN1, >5 pN1, and posttreatment radioactive iodine (RAI)-avid metastatic foci of intermediate risk remained the independent factors predictive of RFS (all P < 0.05). The combination of any three or more of these intermediate-risk factors appeared to increase the posttreatment recurrence rate.
Clinical nodal positivity, the number of positive LNs, and the presence of RAI-avid metastatic foci in the ATA intermediate-risk category might independently decrease RFS in patients with intermediate-risk PTC.
甲状腺乳头状癌（PTC）通常与良好的预后相关，但中危患者需要进一步评估。因此，我们研究了中危 PTC 患者治疗后复发的风险因素。
本研究纳入了 1782 例接受甲状腺切除术治疗的中危 PTC 患者。采用单因素和多因素 Cox 比例风险回归分析来确定预测治疗后无复发生存（RFS）的显著因素。
在中危因素中，单因素分析显示，临床和病理颈淋巴结（cN1 和 pN1）阳性、侵袭性组织学和多灶性伴微小甲状腺外侵犯与 RFS 结果显著相关（均 P<0.05）。多因素分析显示，cN1、>5 pN1 和治疗后放射性碘（RAI）摄取的中等风险转移性病灶仍然是预测 RFS 的独立因素（均 P<0.05）。这些中危因素中的任意三个或更多因素的组合似乎会增加治疗后复发率。
在 ATA 中危类别中，临床淋巴结阳性、阳性淋巴结数量和 RAI 摄取的转移性病灶的存在可能独立降低中危 PTC 患者的 RFS。
