J.J. Chang1, E.M. Henriksen1, C. Saghira2, A. Cioci2, J.I. Lew1,2, T.M. Vaghaiwalla1,2 1University Of Miami, Leonard M. Miller School Of Medicine, Miami, FL, USA 2University Of Miami, DeWitt Daughtry Department Of Surgery, Division Of Endocrine Surgery, Miami, FL, USA
Introduction:
Although the majority of patients with papillary thyroid cancer (PTC) have a favorable prognosis, some PTCs have aggressive features associated with poor outcomes. Predicting PTC tumor behavior remains a clinical dilemma, and has implications for surgical planning to determine the extent of thyroidectomy. This study investigates the association between preoperative clinical factors and aggressive PTC features on final pathology that aid in predicting intermediate/high risk of disease recurrence.
Methods:
A retrospective review of prospectively collected data for 1,104 patients ≥ 18 years of age who underwent thyroidectomy for PTC was performed at a tertiary institution. Preoperative clinical factors were examined including age, sex, BMI, history of neck radiation, family history, palpable nodule, US features, clinically detectable lymph node (LN) metastases, unilateral or bilateral lobe involvement, TSH, and TPO antibody level. Patients were stratified into intermediate/high-, and low-risk groups based on final pathology, as defined by the ATA risk stratification system for risk of recurrence. ATA prognostic variables associated with aggressive PTC include vascular invasion, extrathyroidal extension (ETE), aggressive histology (e.g., tall cell variant), and distant metastases. Analysis was performed using Chi-square and Fisher’s exact tests. A p<0.05 was considered statistically significant.
Results:
Of 1,104 patients, there were 896 women (81.2%) and 208 men (18.8%) with an average age of 47.9 years. Stratified by ATA risk of recurrence, there were 464 intermediate/high-risk and 640 low-risk patients. Comparing proportions within the intermediate/high-risk PTC group to those of the low-risk group, there was a statistically significant difference for age <45 years (44% vs. 35%), male sex (22% vs. 16%), palpable nodule (49% vs. 42%), nodular calcifications (64% vs. 34%), hypoechogenic nodules (81% vs. 70%), irregular borders (60% vs. 38%), nodules taller than wide (22% vs. 14%), and clinically detectable LN metastases (19% vs. 4%), respectively, (p<0.05). When comparing intermediate/high-risk PTC to low-risk patients, no differences in BMI, radiation exposure, family history of thyroid cancer, nodule size, multifocality, lobe involvement, lymph node size, TSH, and TPO antibody levels were identified.
Conclusion:
Preoperative factors, such as age <45 years, male sex, palpable nodules, nodular calcifications, hypoechogenic nodules, border irregularity, taller than wide nodules, and LN metastases correlated with higher risk for PTC recurrence as defined by the ATA risk stratification system. Certain preoperative factors that stratify a higher recurrence risk in patients with PTC may be of value during shared-decision making and surgical planning in the preoperative setting.