Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

J Ruiz Pardo; A Ríos Zambudio; J M Rodríguez González; M Paredes Quiles; V Soriano Giménez; M I Oviedo Ramírez; A M Hernández Martínez; P Parrilla Paricio

doi:10.1016/j.rce.2019.12.010

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

Rev Clin Esp. 2021 Mar;221(3):131-138. doi: 10.1016/j.rce.2019.12.010. Epub 2020 Mar 23.

[Article in English, Spanish]

Authors

J Ruiz Pardo¹, A Ríos Zambudio², J M Rodríguez González², M Paredes Quiles³, V Soriano Giménez³, M I Oviedo Ramírez⁴, A M Hernández Martínez⁵, P Parrilla Paricio²

Affiliations

¹ Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: josrp@hotmail.es.
² Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España.
³ Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
⁴ Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
⁵ Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.

PMID: 32216965
DOI: 10.1016/j.rce.2019.12.010

Abstract

Background: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis.

Material and methods: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis.

Results: We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034).

Conclusions: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

Keywords: Cáncer de tiroides; Cáncer papilar de tiroides; Extensión extratiroidea mínima; Microcarcinoma papilar de tiroides; Minimal extrathyroidal extension; Papillary thyroid cancer; Papillary thyroid microcarcinoma; Prognosis; Pronóstico; Thyroid cancer.