The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study

Young Ki Lee, Daham Kim, Dong Yeob Shin, Cho Rok Lee, Eunjig Lee, Sang Wook Kang, Jandee Lee, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung, Cheong Soo Park

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Abstract

Background: Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis. Methods: This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event. Results: The study enrolled 64 patients. Of these patients, 21 (32.8%) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3% in those with and 92.3% in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0% in those with and 29.3% in those without extensive ETE; p = 0.013). Conclusions: Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.

Original languageEnglish
JournalAnnals of Surgical Oncology
DOIs
Publication statusPublished - 2019 Jan 1

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Cohort Studies
Retrospective Studies
Neoplasm Metastasis
Neoplasms
Survival Rate
Papillary Thyroid cancer
Survival
Incidence
Thyroidectomy
Disease Progression
Cause of Death
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

Lee, Young Ki ; Kim, Daham ; Shin, Dong Yeob ; Lee, Cho Rok ; Lee, Eunjig ; Kang, Sang Wook ; Lee, Jandee ; Jeong, Jong Ju ; Nam, Kee Hyun ; Chung, Woong Youn ; Park, Cheong Soo. / The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension : A Retrospective Cohort Study. In: Annals of Surgical Oncology. 2019.
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title = "The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study",
abstract = "Background: Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis. Methods: This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event. Results: The study enrolled 64 patients. Of these patients, 21 (32.8{\%}) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3{\%} in those with and 92.3{\%} in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0{\%} in those with and 29.3{\%} in those without extensive ETE; p = 0.013). Conclusions: Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.",
author = "Lee, {Young Ki} and Daham Kim and Shin, {Dong Yeob} and Lee, {Cho Rok} and Eunjig Lee and Kang, {Sang Wook} and Jandee Lee and Jeong, {Jong Ju} and Nam, {Kee Hyun} and Chung, {Woong Youn} and Park, {Cheong Soo}",
year = "2019",
month = "1",
day = "1",
doi = "10.1245/s10434-019-07314-x",
language = "English",
journal = "Annals of Surgical Oncology",
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The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension : A Retrospective Cohort Study. / Lee, Young Ki; Kim, Daham; Shin, Dong Yeob; Lee, Cho Rok; Lee, Eunjig; Kang, Sang Wook; Lee, Jandee; Jeong, Jong Ju; Nam, Kee Hyun; Chung, Woong Youn; Park, Cheong Soo.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension

T2 - A Retrospective Cohort Study

AU - Lee, Young Ki

AU - Kim, Daham

AU - Shin, Dong Yeob

AU - Lee, Cho Rok

AU - Lee, Eunjig

AU - Kang, Sang Wook

AU - Lee, Jandee

AU - Jeong, Jong Ju

AU - Nam, Kee Hyun

AU - Chung, Woong Youn

AU - Park, Cheong Soo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis. Methods: This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event. Results: The study enrolled 64 patients. Of these patients, 21 (32.8%) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3% in those with and 92.3% in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0% in those with and 29.3% in those without extensive ETE; p = 0.013). Conclusions: Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.

AB - Background: Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis. Methods: This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event. Results: The study enrolled 64 patients. Of these patients, 21 (32.8%) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3% in those with and 92.3% in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0% in those with and 29.3% in those without extensive ETE; p = 0.013). Conclusions: Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.

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