Surgical management and outcomes of T4a papillary thyroid carcinoma: a single-centre study of 602 cases

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2024-09-12 DOI:10.1007/s12020-024-04026-5

Yang Liu, Yixuan Song, Yuqin He, Ziren Kong, Han Li, Yiming Zhu, Shaoyan Liu

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Abstract

Objective

This study aimed to investigate the clinical characteristics and risk factors associated with the disease progression of T4a papillary thyroid carcinoma (PTC).

Methods

In all, 602 patients (230 males; 372 females), aged 8–82 years, with T4a PTC who were admitted for initial surgery between April 2010 and September 2022 were retrospectively analysed.

Results

Tracheal invasion was observed in 271 (45.0%), oesophageal invasion in 190 (31.6%), recurrent laryngeal nerve (RLN) invasion in 516 (85.7%), and larynx invasion in 22 (3.7%) patients. The 5-year progression-free survival was 89.8%, and disease-specific survival was 96.0%, with a postoperative disease progression rate of 9.6% (54 patients) and mortality rate of 5.17% (29 patients). Disease recurrence was most likely to occur at the initial surgical site. Age ≥55 years, preoperative vocal cord paralysis, microvascular invasion, trachea invasion, and metastases to >5 cervical lymph nodes were independent risk factors for disease progression in patients with M0 stage. Male sex, preoperative vocal cord paralysis, microvascular invasion, specific pathological type, and laryngeal invasion were associated with an increased risk of disease progression for all T4a patients, while lobectomy, total thyroidectomy, tumour shaving on the RLN surface, total RLN resection, and absence of radioactive iodine therapy were not.

Conclusions

Surgery was the primary treatment for patients with stage T4a PTC and most patients had a satisfactory prognosis. Surgeons should comprehensively evaluate each patient before deciding the surgical approach.

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T4a甲状腺乳头状癌的手术治疗和预后：对602个病例的单中心研究

方法回顾性分析2010年4月至2022年9月期间接受初次手术的602例T4a型甲状腺乳头状癌（PTC）患者（男230例；女372例），年龄在8-82岁之间。结果 271例（45.0%）患者观察到气管侵犯，190例（31.6%）患者观察到食管侵犯，516例（85.7%）患者观察到喉返神经（RLN）侵犯，22例（3.7%）患者观察到喉侵犯。5年无进展生存率为89.8%，疾病特异性生存率为96.0%，术后疾病进展率为9.6%（54例患者），死亡率为5.17%（29例患者）。疾病复发最有可能发生在最初的手术部位。年龄≥55岁、术前声带麻痹、微血管侵犯、气管侵犯和转移至>5个颈淋巴结是M0期患者疾病进展的独立危险因素。男性性别、术前声带麻痹、微血管侵犯、特定病理类型和喉侵犯与所有T4a期患者疾病进展风险增加有关，而肺叶切除、甲状腺全切除、RLN表面肿瘤剃除、RLN全切除和未接受放射性碘治疗则与之无关。外科医生在决定手术方法前应全面评估每位患者。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.