Onoda Naoyoshi, Ito Yasuhiro, Miya Akihiro, Kihara Minoru, Miyauchi Akira
Department of Surgery, Kuma Hospital, Kobe, Japan.
World J Surg. 2025 Jan;49(1):117-123. doi: 10.1002/wjs.12289. Epub 2024 Aug 26.
Patients with intermediate-risk papillary thyroid carcinoma (PTC) have a favorable prognosis with standard treatment of total thyroidectomy (TT) and adjuvant radioactive iodine therapy (RAIT). However, the benefits of TT or adjuvant RAIT remain undetermined, and they are often omitted in Japan. We investigated risk factors for life-threatening distant recurrence in patients with intermediate-risk PTC who are optimal candidates for adjuvant RAIT.
Outcomes without RAIT were retrospectively examined in 4030 intermediate-risk conventional PTC cases underwent initial surgery from 2005 to 22 (IRB approval 20200709-1).
Lobectomy (LT) and TT was performed in 11.5% and 88.5%, respectively. Recurrent laryngeal nerve paralysis and hypoparathyroidism was less commonly observed in LT (1.3% and 0%) than TT (2.4% and 3.5 %). Fifty-six cases (1.4%) had distant recurrence. Recurrence-free survival rates at 10 years was 93.5%. There was no significant difference in recurrence rate between LT and TT. Age ≥55, cN1b, and tumor diameter >30 mm significantly associated with distant recurrence. There was a strong relationship between the number of positive risk factors and recurrence; the distant recurrence rate in cases of 0, 1, 2, and 3 positive factors was 0.3% (4/1203), 1.3% (25/1889), 2.7% (23/830) and 7.1% (4/52) (HR 6.46 (2.34-17.86), Log-rank <0.001).
For intermediate-risk conventional PTC, there is no difference in prognosis even if LT was selectively conducted. However, in patients with risk factors for distant metastatic recurrence, such as age ≥55 years, cN1b, and tumor size >30 mm, adjuvant RAIT was considered eligible.
中度风险的乳头状甲状腺癌（PTC）患者通过全甲状腺切除术（TT）和辅助放射性碘治疗（RAIT）的标准治疗预后良好。然而，TT或辅助RAIT的益处仍未确定，在日本它们常常被省略。我们调查了辅助RAIT的最佳候选者——中度风险PTC患者发生危及生命的远处复发的危险因素。
对2005年至2022年接受初次手术的4030例中度风险的传统PTC病例（IRB批准号20200709 - 1）未接受RAIT的结局进行回顾性研究。
分别有11.5%和88.5%的患者接受了甲状腺叶切除术（LT）和TT。与TT（2.4%和3.5%）相比，LT患者喉返神经麻痹和甲状旁腺功能减退的发生率较低（分别为1.3%和0%）。56例（1.4%）出现远处复发。10年无复发生存率为93.5%。LT和TT之间的复发率无显著差异。年龄≥55岁、cN1b和肿瘤直径>30 mm与远处复发显著相关。阳性危险因素的数量与复发之间存在密切关系；0个、1个、2个和3个阳性因素病例的远处复发率分别为0.3%（4/1203）、1.3%（25/1889）、2.7%（23/830）和7.1%（4/52）（HR 6.46（2.34 - 17.86），对数秩检验<0.001）。
对于中度风险的传统PTC，即使选择性地进行LT，预后也没有差异。然而，对于有远处转移复发危险因素的患者，如年龄≥55岁、cN1b和肿瘤大小>30 mm，辅助RAIT被认为是合适的。
