Kim Chae A, Kim Hye In, Kim Na Hyun, Kim Tae Yong, Kim Won Bae, Chung Jae Hoon, Jeon Min Ji, Kim Tae Hyuk, Kim Sun Wook, Kim Won Gu
Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Endocrinol Metab (Seoul). 2025 Jun;40(3):405-413. doi: 10.3803/EnM.2024.2199. Epub 2025 Feb 25.
We aimed to investigate the prognostic significance of primary tumor size in patients with pT1-T3a N0 M0 papillary thyroid carcinoma (PTC), minimizing the impact of confounding factors.
A multicenter retrospective study included 5,759 patients with PTC. Those with lymph node metastasis, gross extrathyroidal extension (ETE), and aggressive variants were excluded. Patients were categorized by primary tumor size (≤1, 1.1-2, 2.1-4, and >4 cm) and subdivided based on the presence of microscopic ETE (mETE).
The median age was 48.0 years, and 87.5% were female. The median primary tumor size was 0.7 cm, with mETE identified in 43.7%. The median follow-up was 8.0 years, with an overall recurrent/persistent disease rate of 2.8%. Multivariate analysis identified male sex, larger tumor size, and the presence of mETE as significant prognostic risk factors. The 10-year recurrent/persistent disease rates for tumors ≤1, 1.1-2, 2.1-4, and >4 cm were 2.5%, 4.7%, 11.1%, and 6.0%, respectively. The 2.1-4 cm group had a significantly higher hazard ratio (HR), with the >4 cm group had the highest HR than the ≤1 cm group. Patients with mETE had a higher recurrent/persistent disease rate (4.5%) than those without, with rates by tumor size being 2.6%, 5.6%, 16.7%, and 8.2%.
Larger tumor size and the presence of mETE significantly increased the risk of recurrent/persistent disease in PTC. Patients with pT2-T3a N0 M0 PTC (>2 cm) had a recurrent/persistent disease risk exceeding 5%, warranting vigilant management.
我们旨在研究pT1-T3a N0 M0 期乳头状甲状腺癌（PTC）患者中原发肿瘤大小的预后意义，同时尽量减少混杂因素的影响。
一项多中心回顾性研究纳入了5759例PTC患者。排除有淋巴结转移、肉眼可见甲状腺外侵犯（ETE）和侵袭性亚型的患者。根据原发肿瘤大小（≤1 cm、1.1-2 cm、2.1-4 cm和>4 cm）对患者进行分类，并根据显微镜下ETE（mETE）的存在情况进一步细分。
中位年龄为48.0岁，女性占87.5%。原发肿瘤大小的中位数为0.7 cm，43.7%的患者存在mETE。中位随访时间为8.0年，总体复发/持续性疾病发生率为2.8%。多因素分析确定男性、肿瘤体积较大和存在mETE是显著的预后危险因素。肿瘤≤1 cm、1.1-2 cm、2.1-4 cm和>4 cm的10年复发/持续性疾病发生率分别为2.5%、4.7%、11.1%和6.0%。2.1-4 cm组的风险比（HR）显著更高，>4 cm组的HR高于≤1 cm组。有mETE的患者复发/持续性疾病发生率（4.5%）高于无mETE的患者，按肿瘤大小分层的发生率分别为2.6%、5.6%、16.7%和8.2%。
肿瘤体积较大和存在mETE显著增加了PTC复发/持续性疾病的风险。pT2-T3a N0 M0期PTC（>2 cm）患者的复发/持续性疾病风险超过5%，需要进行密切管理。
