Impact of gross extrathyroidal extension to the recurrent laryngeal nerve alone on survival in papillary thyroid carcinoma.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2025-03-28 DOI:10.1093/bjs/znaf030

Victoria Harries,Daniel W Scholfield,Alana Eagan,R Michael Tuttle,Ashok R Shaha,Jatin P Shah,Richard J Wong,Snehal G Patel,Ian Ganly

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Abstract

BACKGROUND Gross extrathyroidal extension (ETE) is one of the most important predictors of survival in papillary thyroid carcinoma (PTC). The aim of this study is to determine the impact of gross ETE to the recurrent laryngeal nerve alone (RLNT4aETE) on survival. METHODS After institutional review board approval, adult PTC patients were identified from an institutional database undergoing initial surgery for well-differentiated thyroid carcinoma from 1986 to 2020. Patients were classified as having no gross ETE, gross ETE to strap muscles only (T3bETE), RLNT4aETE, or gross ETE involving other adjacent structures (otherT4aETE). Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and groups were compared using the log-rank test. RESULTS There were 8030 patients included in the analysis; 7578 patients (94.2%) with no gross ETE, 197 (2.4%) with T3bETE, 40 (0.5%) with RLNT4aETE, and 215 (2.7%) with otherT4aETE. The estimated 10-year DSS for patients with no gross ETE, T3bETE, RLNT4aETE, and otherT4aETE in the whole cohort were 99.2%, 95.7%, 96.9%, and 82.5% respectively (P < 0.0001). After controlling for age, nodal and distant disease stage, RLNT4aETE patients had a similar DSS to T3bETE patients, when compared to no gross ETE patients (HRs 2.91 versus 2.28 respectively). In the ≥55-year-old cohort, the 10-year DSS for patients with no gross ETE, T3bETE, RLNT4aETE, and otherT4aETE were 97.7%, 89.4%, 90.9% and 67.6% respectively. CONCLUSION RLNT4aETE patients appear to have a similar DSS to T3bETE patients. This highlights the heterogeneity within the current T4a cohort and supports the downstaging of RLNT4aETE patients to the T3b classification.

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背景甲状腺外总扩展（ETE）是预测甲状腺乳头状癌（PTC）生存率的最重要指标之一。本研究旨在确定单纯喉返神经粗大ETE（RLNT4aETE）对生存率的影响。方法经机构审查委员会批准后，从机构数据库中确定了1986年至2020年期间因分化良好的甲状腺癌接受初次手术的成年PTC患者。患者被分为无严重ETE、仅有带状肌肉严重ETE（T3bETE）、RLNT4aETE或涉及其他邻近结构的严重ETE（otherT4aETE）。采用 Kaplan-Meier 法计算疾病特异性生存率（DSS），并采用对数秩检验对各组进行比较。结果共有 8030 名患者纳入分析，其中 7578 名患者（94.2%）无大面积 ETE，197 名患者（2.4%）有 T3bETE，40 名患者（0.5%）有 RLNT4aETE，215 名患者（2.7%）有 otherT4aETE。在整个队列中，无大面积 ETE、T3bETE、RLNT4aETE 和 otherT4aETE 患者的估计 10 年 DSS 分别为 99.2%、95.7%、96.9% 和 82.5%（P < 0.0001）。在控制了年龄、结节和远处疾病分期后，RLNT4aETE 患者的 DSS 与 T3bETE 患者相似，而无毛发 ETE 患者的 DSS 与 T3bETE 患者相似（HR 分别为 2.91 和 2.28）。结论RLNT4aETE 患者的 DSS 似乎与 T3bETE 患者相似。这凸显了目前 T4a 队列中的异质性，并支持将 RLNT4aETE 患者下调至 T3b 分级。

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

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.