ArticleBrazilian journal of otorhinolaryngology
Prognostic significance of minimal extrathyroidal extension in differentiated thyroid carcinoma: a retrospective cohort study.
Article in Brazilian journal of otorhinolaryngology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the impact of minimal Extrathyroidal Extension (mETE) on structural recurrence, prognostic variables, and disease-free survival in patients with Differentiated Thyroid Carcinoma (DTC) treated surgically.
methodsA retrospective cohort of 629 patients who underwent thyroidectomy for DTC was analyzed. Patients were divided into two groups: Group 1 (n = 413) with tumors confined to the thyroid, and Group 2 (n = 216) with minimal extrathyroidal extension. Clinical, pathological, and biochemical variables were compared between groups. The minimum follow-up period was 30-months or until death, with an average follow-up of 71.5-months. Univariate and multivariate analyses were performed to identify independent predictors of structural recurrence.
resultsStructural recurrence occurred in 6.5% of Group 1 and 22.7% of Group 2 patients (p < 0.001). Group 2 showed significantly higher rates of follicular carcinoma, tumor size > 2 cm, angiolymphatic invasion, pN1 disease, multicentricity, elevated postoperative thyroglobulin (Tg > 10 ng/mL), iodine-refractory disease, distant metastases, and higher late Tg levels (all p < 0.05). Even though the univariate associations were statistically significant, multivariate analysis identified only male sex (p = 0.018), postoperative Tg >10 ng/mL (p < 0.001), and iodine-refractory disease (p < 0.001) as independent predictors of structural recurrence, not mETE. Five-year disease-free survival was 94.1% in Group 1 and 79.2% in Group 2 (p < 0.001).
conclusionMinimal extrathyroidal extension was associated with several adverse prognostic factors and worse outcomes in univariate analysis. However, it was not an independent predictor of structural recurrence or reduced disease-free survival in this cohort. These findings highlight the need to understand mETE in the larger context of risk stratification in management of DTC. LEVEL OF EVIDENCE: 3:
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