Won Ho-Ryun, Kim Ji Won, Son Hyo-One, Yi Sumin, Chang Jae Won, Koo Bon Seok
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Korea.
Clin Exp Otorhinolaryngol. 2024 Nov;17(4):336-345. doi: 10.21053/ceo.2024.00162. Epub 2024 Oct 31.
The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size.
Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted.
Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis.
gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.
分化型甲状腺癌（DTC）患者存在甲状腺外扩展（ETE）是一个重要的预后指标。因此，DTC的分期分为广泛ETE和仅累及带状肌的大体ETE（大体带状肌侵犯[gSMI]）。然而，关于gSMI与预后之间的关系，尤其是在肿瘤大小方面，缺乏足够的证据。
在Medline、Embase、Cochrane图书馆和KoreaMed中检索相关文献。所有程序均按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行，并由两名独立的审阅者执行。Meta分析采用随机效应模型来考虑研究的多样性。使用非随机研究的偏倚风险（RoBANS）2.0版（一种非随机研究的评估工具）来评估所选研究的质量。收集观察性研究中检查ETE程度与预后关系的临床数据，并进行Meta分析。
本分析纳入了18项观察性研究。对每个结果进行了亚组分析。结果显示，gSMI患者的复发率（优势比[OR]，2.498）、疾病特异性死亡率（风险比[RR]）、总死亡率（RR，1.361）和淋巴结（LN）转移率（OR，5.355）显著高于无ETE的患者。然而，当分析仅限于直径4 cm或更小的肿瘤时，除LN转移外，未观察到预后结果有显著差异。
gSMI对预后有负面影响；然而，这种相关性在肿瘤较小的情况下会减弱。因此，在治疗过程中需要采取更谨慎的方法。
