Predictive Factors and Pattern of Locoregional Recurrence After Prophylactic Central Neck Dissection in Papillary Thyroid Carcinoma
| Autor: | Diane T. Y. Chan, Brian Hung-Hin Lang, Koon Yat Wan, Kandy K. C. Wong, Kai Pun Wong |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Urology chemical and pharmacologic phenomena Context (language use) Sensitivity and Specificity Predictive Value of Tests Risk Factors Carcinoma medicine Humans Prospective Studies Thyroid Neoplasms Prospective cohort study Aged Neoplasm Staging business.industry Proportional hazards model fungi Hazard ratio Thyroidectomy Neck dissection Middle Aged Prognosis medicine.disease Carcinoma Papillary Surgery Treatment Outcome Oncology Predictive value of tests Neck Dissection Female Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | Annals of Surgical Oncology. 21:4181-4187 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-014-3872-6 |
| Popis: | Prophylactic central neck dissection (pCND) at the time of the total thyroidectomy (TT) remains controversial in clinically nodal-negative (cN0) papillary thyroid carcinoma. Our study was designed to examine the predictive factors and pattern of locoregional recurrence (LRR) after pCND in the context of the postoperative stimulated Tg (sTg) level. A total of 341 patients who underwent TT and unilateral pCND were analyzed. Patients with an identifiable lesion on ultrasonography or whole-body scan within 6 months of surgery were excluded. LRR was defined as an identifiable lesion on USG, which was later confirmed by cytology/histology. Preablation sTg level was taken 2 months after surgery, whereas postablation sTg level was taken 8 months after surgery. Cox regression was used in the univariate and multivariate analyses to identify significant independent factors for LRR. After a follow-up of 66.6 ± 38.6 months, 14 (4.1 %) suffered from LRR. The duration to first LRR was 36.4 ± 21.7 months. The estimated 5- and 10-year LRR rates were 5.1 and 6.1 %, respectively. Of these 14 LRR, 3 (21.4 %) involved the central compartment alone, 9 (64.3 %) involved the lateral compartment alone, and 2 (14.3 %) involved both central and lateral compartments. After adjusting for other clinicopathological factors, postablation sTg level ≥ 1 µg/L (hazard ratio 265.109, 95 % confidence interval 1.132–62075.644, p = 0.045) was the only independent predictor of LRR. Annualized risk of LRR after pCND was approximately 1 % in the first 5 years and 0.2 % in the subsequent 5 years. Most (78.6 %) LRRs involved the lateral compartment. Postablation sTg ≥ 1 µg/L significantly predicted risk of LRR. |
| Databáze: | OpenAIRE |
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