Heterogeneous prognoses for pT3 papillary thyroid carcinomas and impact of delayed risk stratification.

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Heterogeneous prognoses for pT3 papillary thyroid carcinomas and impact of delayed risk stratification.

Thyroid. 2017 Mar 28;:

Authors: Tavarelli M, Sarfati J, Chereau N, Tissier F, Golmard JL, Ghander C, Lussey-Lepoutre C, Tresallet C, Menegaux F, Leenhardt L, Buffet C

Abstract
BACKGROUND: Papillary thyroid carcinomas (PTC) in the pT3 category constitute a heterogeneous group of tumors with a variable risk of recurrence. This study set a double objective: first, to estimate disease free survival (DFS) and identify prognostic factors associated with recurrence in a cohort of pT3 PTC, and second to evaluate the concept of delayed risk stratification (DRS) in a cohort of pT3 tumors.
METHODS: A total of 560 patients with pT3 PTC, treated and followed up in our institution, were studied. They were divided into 3 groups: group 1: pT3≤10mm, group 2: pT3>10 mm with extra-thyroid invasion (ETI) and group 3: pT3 due to a tumor size > 4 cm. DFS was estimated using the Kaplan-Meier method and associated prognostic features were studied in univariate and multivariate Cox model-based analyses in each group. Then DFS was studied for each group according to the 6-8 months status (remission or not).
RESULTS: DFS at 10 years was 75% for the entire cohort and was 89%, 67% and 82% in groups 1, 2 and 3 respectively (P<0.0001). Multivariate analysis identified 3 factors significantly associated with reduced DFS: lymph node (LN) involvement, male sex and group 2 (>1cm with ETI). A trend towards a worse prognosis in patients with pT3 N0/Nx PTC over 10 mm with ETI was found in comparison with the other pT3 N0/Nx patients. When the 6-8 months check-up was normal, the DFS at 10 years increased to 98%, 96% and 91% in the above three groups. Furthermore, in this case, initial LN involvement no longer seemed to affect the prognosis in those groups.
CONCLUSION: PTC ≤ 10 mm with ETI and large tumors > 4 cm without ETI both have a low-recurrence risk when there are no adverse associated prognostic features such as LN involvement. LN involvement, especially in the lateral compartment (N1b), is a strong prognostic factor of recurrence in pT3 PTC. DRS can be applied in pT3 PTC patients. Those cured at the first check-up, including those with limited lymph node involvement, have excellent outcomes which should prompt clinicians to adapt subsequent management accordingly.

PMID: 28351220 [PubMed - as supplied by publisher]

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