Impact of gross extra-thyroidal extension into major structures in the neck on prognosis in papillary thyroid carcinoma

  • Background: We investigated the impact of survival on gross extra-thyroidal extension, according to changes in the AJCC/TNM staging system.

    Methods: Data of 233 patients with PTC who underwent surgical excision for invasion into surrounding major structures were retrospectively reviewed.

    Results: A total of 160 patients had stage T4AnyNM0 disease (T4aAnyNM0 and T4bAnyNM0 in 145 and 15 patients, respectively); 23 patients had stage T4AnyNM1 disease (T4aAnyNM1 and T4bAnyNM1 in 19 and 4 patients, respectively). The numbers of patients in the T4AnyNM0 group aged less than 45 and 55 years were 23 and 57, respectively; the corresponding numbers in the T4AnyNM1 group were 5 and 9, respectively. The 10-year DSS rate of patients aged less than 45 and 55 years in the T4AnyNM0 group was 100% and 95.6%, respectively (p = 0.216). The 10-year DSS rates of patients in the new edition stages III (T4aAnyNM0, n = 90), IVA (T4bAnyNM0, n = 13), and IVB (T4AnyNM1, n = 14) were 80.6%, 48.5%, and 40.2%, respectively. In 90 patients with stage III tumors, invasion of only the RLN, superficial invasion or intraluminal invasion of the aerodigestive tract was noticed in 15, 34 and 37 patients, respectively. The 10-year DSS rate in the three groups was 100%, 83.5%, and 66.4%, respectively.

    Conclusions: The DSS in cases of gross extra-thyroidal extension into surrounding major structures matched the predicted prognosis of the 8th edition. The differences in organ invasion and the extent or depth of invasion were found to have an impact on prognosis.


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