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      Long-Term Outcome after Hemithyroidectomy for Papillary Thyroid Cancer: A Comparative Study and Review of the Literature

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          Abstract

          Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I 131 were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1–48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome.

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          Most cited references 33

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          Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005.

          Studies have reported an increasing incidence of thyroid cancer since 1980. One possible explanation for this trend is increased detection through more widespread and aggressive use of ultrasound and image-guided biopsy. Increases resulting from increased detection are most likely to involve small primary tumors rather than larger tumors, which often present as palpable thyroid masses. The objective of the current study was to investigate the trends in increasing incidence of differentiated (papillary and follicular) thyroid cancer by size, age, race, and sex. Cases of differentiated thyroid cancer (1988-2005) were analyzed using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) dataset. Trends in incidence rates of papillary and follicular cancer, race, age, sex, primary tumor size ( 4 cm), and SEER stage (localized, regional, distant) were analyzed using joinpoint regression and reported as the annual percentage change (APC). Incidence rates increased for all sizes of tumors. Among men and women of all ages, the highest rate of increase was for primary tumors or =4 cm among men (1988-2005: APC, 3.7) and women (1988-2005: APC, 5.70) and for distant SEER stage disease among men (APC, 3.7) and women (APC, 2.3). The incidence rates of differentiated thyroid cancers of all sizes increased between 1988 and 2005 in both men and women. The increased incidence across all tumor sizes suggested that increased diagnostic scrutiny is not the sole explanation. Other explanations, including environmental influences and molecular pathways, should be investigated.
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            Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy.

            There remains controversy over the type of surgery appropriate for T1T2N0 well differentiated thyroid cancers (WDTC). Current guidelines recommend total thyroidectomy for all but the smallest lesions, despite previous evidence from large institutions suggesting that lobectomy provides similar excellent results. The objective of this study was to report our experience of T1T2N0 WDTC managed by either thyroid lobectomy or total thyroidectomy. Eight hundred eighty-nine patients with pT1T2 intrathyroid cancers treated surgically between 1986 and 2005 were identified from a database of 1810 patients with WDTC. Total thyroidectomy was carried out in 528 (59%) and thyroid lobectomy in 361 (41%) patients. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome by univariate and multivariate analysis were determined using the log rank test and Cox proportional hazards method respectively. With a median follow-up of 99 months, the 10-yr OS, DSS, and RFS for all patients were 92%, 99%, and 98% respectively. Univariate analysis showed no significant difference in OS by extent of surgical resection. Multivariate analysis showed that age over 45 yr and male gender were independent predictors for poorer OS, whereas T stage and type of surgery were not. Comparison of the thyroid lobectomy group and the total thyroidectomy group showed no difference in local recurrence (0% for both) or regional recurrence (0% vs 0.8%, P = .96). Patients with pT1T2 N0 WDTC can be safely managed by thyroid lobectomy alone. Copyright © 2012 Mosby, Inc. All rights reserved.
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              Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients.

              The TNM classification (tumor-node-metastasis) was adopted by the American Joint Committee on Cancer and the International Union against Cancer a decade ago to avoid heterogeneity of prognostic classification schemes used for differentiated thyroid cancers. To date, however, clinical data based on this classification are lacking. We retrospectively evaluate the prognosis of 700 patients (208 men and 492 women) with papillary (89%) and follicular (11%) thyroid cancers according to the pathological TNM (pTNM) staging system, treated over a 25-yr period (1970-1995). Patients who received primary treatment at our center constituted 87.4% of the cases; the majority underwent total thyroidectomy, followed by 131I ablative therapy in high risk groups, as standard treatment. Clinical and follow-up data were obtained from the medical records and our cancer registry. Disease-free and cancer-specific survival data were analyzed by Kaplan-Meier product limit estimates and Cox proportional hazard models. Patient distribution by the pTNM system were: stage I, 516 patients; stage II, 57 patients; stage III, 104 patients; and stage IV, 23 patients. Over a mean +/- SE follow-up of 11.3 +/- 0.3 yr, the overall cancer recurrence and mortality rates were 20.5% and 8.4%, respectively. However, the respective cancer recurrence and mortality rates were distinctly different in the various pTNM stages: 15.4% and 1.7% in stage I, 22% and 15.8% in stage II, 46.4% and 30% in stage III, and 66.7% and 60.9% in stage IV tumors. Using actuarial survival plots, a clear separation in both disease-free survival and cancer-specific survival was noted among all the stages (P < 0.0001). Risk factors analyses showed a significant association between all the prognostic variables used in TNM staging (age, tumor size, extent of primary tumor, and presence of nodal or distant metastases) and the observed end points of recurrence or death from thyroid cancer. After correcting for TNM stages, the risk of cancer recurrence was halved in female compared to male patients, whereas this was 1.7-fold higher in multifocal than unifocal tumors. Conversely, cancer mortality was 3.4-fold higher in follicular than papillary thyroid cancer. In the analysis of effect of primary treatment among 492 patients with tumor more advanced than the T1N0M0 category, patients who underwent less extensive surgery (lobectomy or subtotal thyroidectomy) had a 2.5-fold risk of cancer recurrence (P < 0.0001) and a 2.2-fold risk of death (P < 0.01) compared to those who underwent total or near-total thyroidectomy. Patients not treated with 131I ablation had a 2.1-fold greater risk of cancer recurrence (P < 0.0001) than those given 131I ablation, although no difference was noted in deaths from thyroid cancer. Based on our data, the pTNM classification is useful in distinguishing patients with different prognostic outcomes. However, the small patient numbers in pTNM stages other than stages I precludes us from evaluating its usefulness as a guide for therapy. Until prospective data could be accrued from controlled treatment trials, we support the standard practice of total thyroidectomy followed by 131I ablative therapy (if focal iodide uptake was noted) in patients with papillary thyroid cancer more advanced than the T1N0M0 category or of multicentric nature and in the majority of patients with follicular thyroid cancer.
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                Author and article information

                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                27 December 2018
                January 2019
                : 11
                : 1
                Affiliations
                [1 ]Endocrine Institute, Assaf Harofeh Medical Center, Zerifin 70300, Beer Ya’akov, Israel; carlosb@ 123456netvision.net.il (C.B.); stein77m@ 123456gmail.com (M.S.); shlomitks@ 123456gmail.com (S.K.); or.karen@ 123456gmail.com (K.O.); rindefrat@ 123456yahoo.com (E.M.)
                [2 ]Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv 69978, Tel-Aviv, Israel; daniaron@ 123456netvision.net.il (D.H.); Limormuallem@ 123456gmail.com (L.M.K.)
                [3 ]Endocrine Institute, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva 49100, Israel
                [4 ]Head and Neck Surgery Unit, Department of ENT, Assaf Harofeh Medical Center, Zerifin 70300, Beer Ya’akov, Israel
                Author notes
                [* ]Correspondence: yosgeron@ 123456gmail.com ; Tel.: +972-545-881-128
                Article
                cancers-11-00026
                10.3390/cancers11010026
                6356549
                30591680
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

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