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Management of 2?4 cm Papillary Thyroid Carcinoma: Risk of Recurrence Compared to 1?2 cm and >4 cm

Journal of Endocrine Surgery 2020년 20권 4호 p.78 ~ 87
김민회, 이준협, 김윤영, 전용순, 박흥규, 최상태, 강진모, 정유승,
소속 상세정보
김민회 ( Kim Min-Hoi ) - Gachon University Gil Medical Center Department of Surgery
이준협 ( Lee Joon-Hyop ) - Gachon University Gil Medical Center Department of Surgery
김윤영 ( Kim Yun-Yeong ) - Gachon University Gil Medical Center Department of Surgery
전용순 ( Chun Yong-Soon ) - Gachon University Gil Medical Center Department of Surgery
박흥규 ( Park Heung-Kyu ) - Gachon University Gil Medical Center Department of Surgery
최상태 ( Choi Sang-Tae ) - Gachon University Gil Medical Center Department of Surgery
강진모 ( Kang Jin-Mo ) - Gachon University Gil Medical Center Department of Surgery
정유승 ( Chung Yoo-Seung ) - Gachon University Gil Medical Center Department of Surgery

Abstract


Purpose: Clinicians still debate how to manage 2?4 cm papillary thyroid carcinoma (PTC). To understand the characteristics and prognosis of these tumors, we compared clinicopathological prognostic factors and prognosis among 1?2 cm, 2?4 cm, and >4 cm PTC.

Methods: We retrospectively reviewed the medical records of 2,079 patients with primary PTC >1 cm who were diagnosed between 2002 and 2017.

Results: The patients' mean age was 47.9±12.5 years, and 83.2% were women. The follow-up period was 81.1±41.8 months. The tumor recurred in 138 patients (6.6%), and thyroid cancer-related death developed in 3 cases (0.1%). As tumor size increased, so did the proportion of male patients, lymphovascular invasion, resection margin positivity, lymph node (LN) metastasis, metastasis in >5 LNs, T4, N stage, and M stage. Recurrence increased linearly according to tumor size, as did distant metastasis as first recurrence and progression to distant metastasis. Tumor size, N stage, metastasis in >5 LNs, and LN metastasis were significant independent risk factors for PTC recurrence. The recurrence rate of 2?4 cm PTC was 13.4%, while the risk of recurrence was 3 times higher than in 1?2 cm PTC. The 5-year recurrence free survival (RFS) rates of 1?2 cm, 2?4 cm, and >4 cm PTC were 97.0%, 88.0%, and 74.0%, respectively, while the 10-year RFS rates were 95.0%, 84.0%, and 71.0%.

Conclusion: The 2?4 cm PTC may be pathologically distinct from 1?2 cm PTC and should be treated differently.

키워드

Papillary thyroid carcinoma; Prognosis; Recurrence; Disease free survival

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