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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12.	鄧暢, 楊志欣, 蘇新良. 甲狀腺乳頭狀癌復發及持續狀態再次手術臨床分析. 中華內分泌外科雜志, 2023, 17(6): 724-728.
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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.
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甲狀腺峽部乳頭狀癌中央區淋巴結轉移規律及手術范圍的探討. 中華內分泌外科雜志, 2021, 15(4): 368-372.
18.	鄭王虎, 李超, 孫榮昊, 等. cN0甲狀腺乳頭狀癌中央區淋巴結亞區清掃的研究進展. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(8): 799-803.
19.	鄭福慶, 張立永, 王波, 等. 甲狀腺乳頭狀癌頸側區淋巴結轉移的危險因素研究進展. 中華普通外科學文獻 (電子版), 2020, 14(5): 384-387.
20.	趙淑艷, 程若川, 馬云海, 等. cN0 T1/T2期甲狀腺乳頭狀癌中央區淋巴結轉移規律的臨床研究. 中華內分泌外科雜志, 2019, 13(4): 283-288.

1. 張浩, 項敬哲, 孫威. 分化型甲狀腺癌的復發治療. 西安交通大學學報 (醫學版), 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. 劉文, 程若川, 張建明, 等. 云南省單中心279例甲狀腺乳頭狀癌再手術原因分析. 中國普通外科雜志, 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. 何高飛, 姜金汐, 褚俊杰, 等. 改良無充氣經單側鎖骨下入路腔鏡甲狀腺全切除術治療甲狀腺乳頭狀癌的臨床分析. 西安交通大學學報 (醫學版), 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. 鄧暢, 楊志欣, 蘇新良. 甲狀腺乳頭狀癌復發及持續狀態再次手術臨床分析. 中華內分泌外科雜志, 2023, 17(6): 724-728.
13. 吳斐, 周陽, 劉珊珊, 等. 甲狀腺乳頭狀癌再次手術的原因及初步經驗. 腫瘤預防與治療, 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甲狀腺峽部乳頭狀癌中央區淋巴結轉移規律及手術范圍的探討. 中華內分泌外科雜志, 2021, 15(4): 368-372.
18. 鄭王虎, 李超, 孫榮昊, 等. cN0甲狀腺乳頭狀癌中央區淋巴結亞區清掃的研究進展. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(8): 799-803.
19. 鄭福慶, 張立永, 王波, 等. 甲狀腺乳頭狀癌頸側區淋巴結轉移的危險因素研究進展. 中華普通外科學文獻 (電子版), 2020, 14(5): 384-387.
20. 趙淑艷, 程若川, 馬云海, 等. cN0 T1/T2期甲狀腺乳頭狀癌中央區淋巴結轉移規律的臨床研究. 中華內分泌外科雜志, 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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