Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection for N1b Intermediate-Risk Papillary Thyroid Carcinoma.

IF 6 1区医学 Q1 OTORHINOLARYNGOLOGY

JAMA otolaryngology-- head & neck surgery Pub Date : 2024-11-27 DOI:10.1001/jamaoto.2024.3860

Yoshiyuki Saito, Kenichi Matsuzu, Amr H Abdelhamid Ahmed, Kosuke Inoue, Hiroshi Shibuya, Ai Matsui, Yoko Kuga, Reiko Ono, Kana Yoshioka, Chie Masaki, Junko Akaishi, Kiyomi Y Hames, Ritsuko Okamura, Chisato Tomoda, Akifumi Suzuki, Wataru Kitagawa, Mitsuji Nagahama, Kiminori Sugino, Hiroshi Takami, Gregory W Randolph, Koichi Ito

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引用次数: 0

Abstract

Importance: The management of papillary thyroid carcinoma (PTC), particularly in cases with clinically apparent lateral neck lymph node metastasis (cN1b), remains an area of debate. The surgical options for PTC, including total thyroidectomy and lobectomy, have distinct impacts on patients' outcomes and quality of life.

Objective: To compare survival and recurrence outcomes between patients who underwent a lobectomy plus ipsilateral lateral neck dissection (LND) and those who underwent a total thyroidectomy plus ipsilateral LND for intermediate-risk cN1b PTC with both primary tumors and lymph node metastases in the ipsilateral neck region.

Design, setting, and participants: This retrospective cohort study was conducted at Ito Hospital, Tokyo, Japan. Patients who underwent surgery for PTC between January 2005 and December 2012 were included, and those with high-risk PTCs and concurrent other thyroid cancers were excluded. Data were analyzed from April to August 2024.

Exposures: Lobectomy plus LND vs total thyroidectomy plus LND.

Main outcomes and measures: An inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis and a Cox proportional hazards regression analysis were performed to compare the patients' overall survival, recurrence-free survival (RFS), and modified RFS (which considered the potential need for a future contralateral lobectomy).

Results: Of 401 included patients, 317 (79.1%) were female, and the median (IQR) age was 47 (36-59) years. A total of 157 patients underwent lobectomy plus ipsilateral LND and 244 underwent total thyroidectomy plus ipsilateral LND. The median (IQR) follow-up time was 13.0 (11.2-15.0) years. The IPTW-adjusted overall survival rates at 5, 10, and 15 years were 98.0% (95% CI, 93.9-99.3), 97.5% (95% CI, 93.2-99.1), and 96.8% (95% CI, 92.2-98.7), respectively, for the lobectomy group vs 99.4% (95% CI, 97.0-99.9), 97.4% (95% CI, 94.4-98.8), and 96.9% (95% CI, 93.3-98.5), respectively, for the total thyroidectomy group (hazard ratio [HR], 1.10; 95% CI, 0.35-3.47). The IPTW-adjusted RFS rates at 5, 10, and 15 years were 93.8% (95% CI, 88.5-96.7), 88.4% (95% CI, 82.0-92.6), and 84.1% (95% CI, 76.8-89.3), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 1.41; 95% CI, 0.79-2.54). The IPTW-adjusted modified RFS rates at 5, 10, and 15 years were 96.7% (95% CI, 92.2-98.6), 93.8% (95% CI, 88.5-96.7), and 88.9% (95% CI, 82.4-93.1), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 0.93; 95% CI, 0.49-1.76).

Conclusions and relevance: In this study, for these selected intermediate-risk cN1b PTC cases, total thyroidectomy and lobectomy provided comparable outcomes in terms of prognosis and recurrence. These data may help inform future guideline revisions and support joint decision-making between patients and their clinicians.

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N1b中危甲状腺乳头状癌的甲状腺叶切除术与全甲状腺切除术加同侧颈部切除术的比较

重要性：甲状腺乳头状癌（PTC）的治疗，尤其是临床上有明显颈侧淋巴结转移（cN1b）的病例，仍然是一个争论不休的领域。PTC的手术方案，包括甲状腺全切除术和甲状腺叶切除术，对患者的预后和生活质量有着不同的影响：目的：比较接受甲状腺叶切除术加同侧颈部外侧清扫术（LND）和甲状腺全切除术加同侧LND的中危cN1b PTC同侧颈部原发肿瘤和淋巴结转移患者的生存率和复发率：这项回顾性队列研究在日本东京伊藤医院进行。研究纳入了2005年1月至2012年12月期间接受PTC手术的患者，并排除了高危PTC患者和同时患有其他甲状腺癌的患者。数据分析时间为2024年4月至8月：主要结果和测量指标：对患者的总生存期、无复发生存期（RFS）和改良RFS（考虑了未来对侧肺叶切除术的潜在需求）进行了逆治疗概率加权（IPTW）调整后的卡普兰-梅耶分析和考克斯比例危险回归分析：在纳入的 401 例患者中，317 例（79.1%）为女性，中位（IQR）年龄为 47（36-59）岁。共有157名患者接受了甲状腺叶切除术加同侧LND，244名患者接受了甲状腺全切除术加同侧LND。随访时间中位数（IQR）为13.0（11.2-15.0）年。经IPTW调整的5年、10年和15年总生存率分别为98.0%（95% CI，93.9-99.3）、97.5%（95% CI，93.2-99.1）和96.8%（95% CI，92.2-98.7）。4%（95% CI，97.0-99.9）、97.4%（95% CI，94.4-98.8）和96.9%（95% CI，93.3-98.5）（危险比[HR]，1.10；95% CI，0.35-3.47）。经IPTW调整的5年、10年和15年RFS率分别为93.8%（95% CI，88.5-96.7）、88.4%（95% CI，82.0-92.6）和84.1%（95% CI，76.8-89.3）。4%（95% CI，91.8-97.4）、92.9%（95% CI，88.8-95.5）和87.8%（95% CI，80.8-92.4）（HR，1.41；95% CI，0.79-2.54）。经IPTW调整的5年、10年和15年改良RFS率分别为96.7%（95% CI，92.2-98.6）、93.8%（95% CI，88.5-96.7）和88.9%（95% CI，82.4-93.1）。4%（95% CI，91.8-97.4）、92.9%（95% CI，88.8-95.5）和87.8%（95% CI，80.8-92.4）（HR，0.93；95% CI，0.49-1.76）：在这项研究中，对于这些选定的中危 cN1b PTC 病例，甲状腺全切除术和甲状腺叶切除术在预后和复发方面的效果相当。这些数据可能有助于为未来的指南修订提供信息，并支持患者及其临床医生共同做出决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA otolaryngology-- head & neck surgery OTORHINOLARYNGOLOGY-

CiteScore

9.10

自引率

5.10%

发文量

230

期刊介绍： JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.