Kwon Hyungju, Kim Hyeji, Hwang Hyeonuk, Moon Byung-In
Department of Surgery, Ewha Womans University Medical Center, Seoul, Republic of Korea.
Department of Surgery, Ewha Womans University Medical Center, Seoul, Republic of Korea.
Eur J Surg Oncol. 2025 Sep;51(9):110208. doi: 10.1016/j.ejso.2025.110208. Epub 2025 May 29.
A positive surgical margin (PSM) is identified in about 10 % of patients with thyroid cancer. Macroscopic PSM indicates overt residual cancer, which can cause remnant tumor regrowth or metastasis, leading to worse outcomes. However, most patients with PSM have only microscopic margin involvement, whose prognostic implications remain unclear. This study investigated the impact of microscopic PSM on recurrence in patients with papillary thyroid carcinoma (PTC).
Between 2009 and 2023, 1495 patients who underwent total thyroidectomy for PTC were enrolled. A 1:3 propensity score matching was performed to adjust for potential confounders. The primary outcome measure was 5-year recurrence-free survival.
A microscopic PSM was found in 68 (4.5 %) patients and was associated with larger tumor size (p = 0.003), extrathyroidal extension (p < 0.001), multifocality (p = 0.001), and lymph node metastasis (p = 0.016). After a mean follow-up of 7.7 years, 37 patients experienced disease recurrence: 6 (9.2 %) in the microscopic-PSM group and 31 (2.2 %) in the clear-margin group. The 5-year recurrence-free survival rate was significantly worse in the microscopic-PSM group (90.1 % vs. 98.2 %; p = 0.003). A microscopic PSM increased the risk of recurrence by approximately fivefold (hazard ratio 4.958, 95 % confidence interval 1.996-12.31) compared with a clear margin.
Microscopic margin involvement was associated with an increased risk of recurrence in patients with PTC. Patients with microscopic PSM require judicious treatment and follow-up strategies.
约10%的甲状腺癌患者存在手术切缘阳性（PSM）。肉眼可见的手术切缘阳性表明存在明显的残留癌，这可能导致残余肿瘤复发或转移，从而导致更差的预后。然而，大多数手术切缘阳性的患者仅存在镜下切缘受累，其对预后的影响仍不明确。本研究调查了镜下手术切缘阳性对甲状腺乳头状癌（PTC）患者复发的影响。
2009年至2023年期间，纳入了1495例行PTC全甲状腺切除术的患者。进行1:3倾向评分匹配以调整潜在的混杂因素。主要结局指标为5年无复发生存率。
68例（4.5%）患者存在镜下手术切缘阳性，且与肿瘤体积较大（p = 0.003）、甲状腺外侵犯（p < 0.001）、多灶性（p = 0.001）和淋巴结转移（p = 0.016）相关。平均随访7.7年后，37例患者出现疾病复发：镜下手术切缘阳性组6例（9.2%），切缘阴性组31例（2.2%）。镜下手术切缘阳性组的5年无复发生存率明显更差（90.1%对98.2%；p = 0.003）。与切缘阴性相比，镜下手术切缘阳性使复发风险增加约五倍（风险比4.958，95%置信区间1.996 - 12.31）。
镜下切缘受累与PTC患者复发风险增加相关。存在镜下手术切缘阳性的患者需要谨慎的治疗和随访策略。
