Introduction: Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence. Methods: In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or #x3e;40 mm). Results: A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors #x3e;40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001). Conclusion: The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.
Eur Thyroid J

中文翻译：

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甲状腺癌肺叶切除术的长期结果

简介：美国甲状腺协会 (ATA) 的最新指南表明，对于甲状腺肿瘤 ≤ 40 mm、无甲状腺外扩散或淋巴结转移的低至中危患者，肺叶切除术可能足以治疗。本研究旨在评估分化型甲状腺癌肺叶切除术后的长期复发情况，并分析与复发相关的因素。方法：在这项回顾性队列研究中，纳入了 1970 年至 2010 年间在一家三级中心因甲状腺癌接受肺叶切除术的患者。结果是病理证实的甲状腺癌复发的比例，根据肿瘤大小（≤或#x3e;40 mm）在整个队列或亚组中进行评估。结果：共纳入 295 名患者，平均随访时间（标准差，SD）19.1（7.8）年（5,649 患者年）；61 名 (20.7%) 为男性，诊断时的平均 (SD) 年龄为 39.7 (12) 岁。263 名 (89.2%) 患者的组织学亚型为乳头状，平均癌症大小为 22.9 (16.9) mm。根据 2015 年 ATA 指南，271 例（91.9%）癌症复发风险较低，24 例（8.1%）为中等风险。54 名患者 (18.3%) 进行了再次手术，40 名患者 (13.6%) 确认复发，55% 的病例在初次手术后 10 年以上被确诊。在复发患者中，14 名（队列的 4.8%）因对侧甲状腺微小乳头状癌而手术，26 名（队列的 8.8%）因局部或转移性复发而手术。对 53 名 (18.0%) 患者的非可疑结节复发进行了监测，无需再次手术。随访结束时，282 名（95.6%）患者处于缓解期。具有局部或转移性复发的肿瘤在具有侵袭性组织学的肿瘤中更常见（19.2% vs. 4.1%，p = 0.015）和中等风险类别（28.6 对 7.1%，p = 0.018）。根据 2015 年 ATA 指南标准，本应通过甲状腺切除术治疗的肿瘤 #x3e;40 mm 在 34 名 (11.5%) 患者中发现，并且与较高的复发频率相关（20.6 对 7.3%，p = 0.024 ) 和更少的缓解（85.3 对 96.9%，p = 0.001）。结论：甲状腺癌叶切除术治疗效果非常好，特别是对于≤40 mm的癌。由于晚期复发的风险，需要长期随访。
欧洲甲状腺杂志