Analysis of the location and characteristics of postoperative recurrence of papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

BAI Yang , MA Weike , ZHOU Bin , ZHANG Luyao , LI Yanqing ,  HEI Hu

Department of Thyroid and Neck Surgery, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou 450008, P. R. China;

Corresponding author：

HEI Hu, Email: tigerblack@126.com

Keywords：

papillary thyroid carcinoma; postoperative recurrence; lymph node metastasis; extracapsular invasion; multiple surgeries

DOI：

10.7507/1007-9424.202404084

Video：

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Objective To explore the location and characteristics of postoperative recurrence of papillary thyroid carcinoma. Methods The clinical data of 96 patients who underwent reoperation for papillary thyroid cancer at the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to March 2024 were retrospectively analyzed. Results Out of 96 patients, 3 had thyroid recurrence, 89 had lymph node recurrence, and 4 had thyroid and lymph node recurrence. There were 69 cases of single recurrence and 27 cases of multiple recurrence. Ten cases underwent lobectomy and lateral area cleaning, 8 cases underwent central area cleaning, 33 cases underwent lateral area cleaning, and 45 cases underwent central area+lateral area cleaning. Postoperative pathological examination revealed that there was lymph node metastasis in 93 cases (16 cases in the central region, 44 cases in the lateral region, and 33 cases in both the central and lateral regions), with 3 cases remaining non metastatic; 58 cases had extracapsular invasion of lymph nodes. Compared with patients with multiple relapses, patients with single recurrence had younger age (t=–3.385, P=0.001), lower incidence of gross extracapsular invasion of lymph nodes during surgery (χ²=6.970, P=0.008), higher number of metastatic lymph nodes (t=4.034, P=0.001), and higher rate of lymph node metastasis in zones Ⅱ, Ⅲ, and Ⅳ (χ²=8.142, P=0.004; χ²=6.357, P=0.012; χ²=12.547, P<0.001). Conclusions Postoperative recurrence of papillary thyroid cancer is mainly due to lymph node recurrence. The advanced age and the visible lymph node extracapsular invasion may increased risk of postoperative recurrence of papillary thyroid cancer. Lymph node metastasis in the central region is a possible cause of multiple relapses and surgeries.

Citation： BAI Yang, MA Weike, ZHOU Bin, ZHANG Luyao, LI Yanqing, HEI Hu. Analysis of the location and characteristics of postoperative recurrence of papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1336-1340. doi: 10.7507/1007-9424.202404084 Copy

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14.	Zhang F, Zheng B, Yu X, et al. Risk factors for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma: a retrospective study and meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 675643. doi: 10.3389/fendo.2021.675643.
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16.	Hei H, Zhou B, Gong W, et al. Preoperative prediction of central neck metastasis in patients with clinical T1-2N0 papillary thyroid carcinoma. Surg Today, 2023, 53(4): 507-512.
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18.	郑王虎, 李超, 孙荣昊, 等. cN0甲状腺乳头状癌中央区淋巴结亚区清扫的研究进展. 中华耳鼻咽喉头颈外科杂志, 2020, 55(8): 799-803.
19.	郑福庆, 张立永, 王波, 等. 甲状腺乳头状癌颈侧区淋巴结转移的危险因素研究进展. 中华普通外科学文献 (电子版), 2020, 14(5): 384-387.
20.	赵淑艳, 程若川, 马云海, 等. cN0 T1/T2期甲状腺乳头状癌中央区淋巴结转移规律的临床研究. 中华内分泌外科杂志, 2019, 13(4): 283-288.

1. 张浩, 项敬哲, 孙威. 分化型甲状腺癌的复发治疗. 西安交通大学学报 (医学版), 2024, 45(1): 23-27.
2. Grant CS. Recurrence of papillary thyroid cancer after optimized surgery. Gland Surg, 2015, 4(1): 52-62.
3. Nixon IJ, Simo R, Newbold K, et al. Management of invasive differentiated thyroid cancer. Thyroid, 2016, 26(9): 1156-1166.
4. 刘文, 程若川, 张建明, 等. 云南省单中心279例甲状腺乳头状癌再手术原因分析. 中国普通外科杂志, 2017, 26(11): 1383-1391.
5. Lang BH, Wong CK, Yu HW, et al. Postoperative nomogram for predicting disease-specific death and recurrence in papillary thyroid carcinoma. Head Neck, 2016, 38 Suppl 1: E1256-E1263.
6. Ou D, Chen C, Jiang T, et al. Research review of thermal ablation in the treatment of papillary thyroid carcinoma. Front Oncol, 2022, 12: 859396. doi: 10.3389/fonc.2022.859396.
7. 何高飞, 姜金汐, 褚俊杰, 等. 改良无充气经单侧锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的临床分析. 西安交通大学学报 (医学版), 2024, 45(1): 80-86.
8. Ntelis S, Linos D. Efficacy and safety of radiofrequency ablation in the treatment of low-risk papillary thyroid carcinoma: a review. Hormones (Athens), 2021, 20(2): 269-277.
9. So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg, 2018, 50: 94-103.
10. Min Y, Huang Y, Wei M, et al. Preoperatively predicting the central lymph node metastasis for papillary thyroid cancer patients with Hashimoto’s thyroiditis. Front Endocrinol (Lausanne), 2021, 12: 713475.
11. Liu FH, Kuo SF, Hsueh C, et al. Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis. J Surg Oncol, 2015, 112(2): 149-154.
12. 邓畅, 杨志欣, 苏新良. 甲状腺乳头状癌复发及持续状态再次手术临床分析. 中华内分泌外科杂志, 2023, 17(6): 724-728.
13. 吴斐, 周阳, 刘珊珊, 等. 甲状腺乳头状癌再次手术的原因及初步经验. 肿瘤预防与治疗, 2020, 33(6): 513-518.
14. Zhang F, Zheng B, Yu X, et al. Risk factors for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma: a retrospective study and meta-analysis. Front Endocrinol (Lausanne), 2021, 12: 675643. doi: 10.3389/fendo.2021.675643.
15. Hei H, Luo Z, Zheng C, et al. Lymph node ratio independently associated with postoperative thyroglobulin levels in papillary thyroid cancer. Oral Oncol, 2023, 146: 106563. doi: 10.1016/j.oraloncology.2023.106563.
16. Hei H, Zhou B, Gong W, et al. Preoperative prediction of central neck metastasis in patients with clinical T1-2N0 papillary thyroid carcinoma. Surg Today, 2023, 53(4): 507-512.
17. 王雨豪, 胡代星, 朱江, 等. cN0甲状腺峡部乳头状癌中央区淋巴结转移规律及手术范围的探讨. 中华内分泌外科杂志, 2021, 15(4): 368-372.
18. 郑王虎, 李超, 孙荣昊, 等. cN0甲状腺乳头状癌中央区淋巴结亚区清扫的研究进展. 中华耳鼻咽喉头颈外科杂志, 2020, 55(8): 799-803.
19. 郑福庆, 张立永, 王波, 等. 甲状腺乳头状癌颈侧区淋巴结转移的危险因素研究进展. 中华普通外科学文献 (电子版), 2020, 14(5): 384-387.
20. 赵淑艳, 程若川, 马云海, 等. cN0 T1/T2期甲状腺乳头状癌中央区淋巴结转移规律的临床研究. 中华内分泌外科杂志, 2019, 13(4): 283-288.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the location and characteristics of postoperative recurrence of papillary thyroid carcinoma

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