Recommendation for subclass evaluation of tnm stage iva papillary thyroid carcinomas: t4an1b patients are at risk for recurrence

Abstract
Background  Although all tumor, node, metastasis system (TNM) stage IVA papillary thyroid carcinomas (PTCs) do not seem to behave equivalently
as a result of various tumor and node stages, to our knowledge, subclass evaluation has never been attempted.

Methods  We reviewed 119 stage IVA PTC patients who underwent initial thyroidectomy with modified neck dissection as curative surgery
at our institution (33 male patients, 86 female patients; age 61.6 years; follow-up 87.7 months). These patients were divided
into groups A (T1–3N1b; n = 79), B (T4aN0–1a; n = 9), and C (T4aN1b; n = 31). Outcomes were compared between the groups.

Results  The rates of recurrence (P < .05) and disease mortality (P < .001) were 13.9% and 1.3%, 0% and 0%, and 35.5% and 19.4% in groups A, B, and C, respectively. The 10-year disease-free
survival (DFS) and disease-specific survival (DSS) were 73.4% and 97.9%, 100% and 100%, and 54.9% and 69.7% in groups A, B,
and C, respectively. DFS and DSS curves differed significantly between group A + B and group C (P < .005 and P < .0005, respectively). The relative risks of DFS and DSS in group C were 2.8-fold and 14.9-fold, respectively, compared
with group A (P < .05), and 3.2-fold and 17.5-fold compared with group A + B (P < .01). Thus, outcomes were worse in group C. In multivariate analysis, esophageal invasion and lymphadenopathy were independent
risk factors for both DFS and DSS in stage IVA PTC patients.

Conclusions  Outcomes in stage IVA are not equivalent, and patients with T4aN1b are at greater risk for worse prognosis. Therefore, we
recommend subclass evaluation for TNM stage IVA PTCs.

Content Type Journal ArticleCategory Endocrine TumorsDOI 10.1245/s10434-008-9837-xAuthors
Nobuyuki Wada, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanKatsuhiko Masudo, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanHirotaka Nakayama, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanNobuyasu Suganuma, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanKenichi Matsuzu, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanShohei Hirakawa, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanYasushi Rino, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanMunetaka Masuda, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 JapanToshio Imada, Yokohama City University Hospital and Medical Center Department of General Surgery 3-9 Fukuura, Kanazawa-ku Yokohama City Kanagawa 236-0004 Japan

Journal Annals of Surgical OncologyOnline ISSN 1534-4681Print ISSN 1068-9265 (Source: Annals of Surgical Oncology)