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J Clin Endocrinol Metab. 2014 Aug;99(8):2834-43. doi: 10.1210/jc.2013-2118. Epub 2014 May 14.

Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up.

Author information

1
Institute of Head and Neck Studies and Education, School of Cancer Sciences (H.M., T.A., N.C.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Cancer Research Clinical Trials Unit, School of Cancer Sciences (B.C., E.M.), University of Birmingham, Birmingham B15 2TT, United Kingdom; University Hospitals Birmingham NHS Foundation Trust (J.W.), University of Birmingham, Birmingham B15 2TT, United Kingdom; and School of Clinical and Experimental Medicine (C.M., K.B., J.A.F.), University of Birmingham, Birmingham B15 2TT, United Kingdom.

Abstract

CONTEXT:

There is controversy as to whether papillary thyroid microcarcinoma (PTMC) represents more than one disease entity with different outcomes, requiring different treatment.

OBJECTIVES:

To compare characteristics, outcomes, and factors associated with prognosis of incidental and nonincidental PTMC.

SETTING AND DESIGN:

Two reviewers performed searches of online databases (1966-2012), reference lists, and conference abstract books. Longitudinal studies of subjects >16 years old receiving any treatments for papillary thyroid cancer ≤10 mm in size were included. Two reviewers independently screened abstracts and articles, extracted data, and assessed quality of studies using National Institute of Clinical Excellence and PRISMA criteria.

RESULTS:

Of 1102 abstracts identified, 262 studies were reviewed and 17 studies included, comprising 3523 subjects, with mean follow-up of 70 months and total follow-up of 21 329 person-years. This included 854 subjects with incidental PTMC (follow-up, 4800 person-years; mean tumor size, 4.6 mm [range 3.3-6.7 mm]) and 2669 nonincidental PTMC cases (follow-up, 16 529 person-years; mean tumor size, 6.9 mm [range 5.6-8.0 mm]). The recurrence rate in the incidental group (0.5%; 95% confidence interval [CI], 0-1%, P < .001) was significantly lower than that in the nonincidental group PTMC (7.9%; 95% CI, 5-11%), with an OR of recurrence of 14.7 (95% CI, 5.6-54.8, P < .001) for nonincidental PTMC, compared with incidental PTMC. Lymph nodes were involved in 80% (126/157) of recurrences. On meta-regression, age, sex, size, tumor multifocality, lymph node involvement, and treatment modality were not significantly associated with recurrence.

CONCLUSIONS:

Our meta-analysis strongly suggests the existence of at least two distinct entities of PTMC. Incidental PTMC has different clinical characteristics and a much lower recurrence rate than nonincidental PTMC, suggesting that management protocols should be re-considered. Additional studies with standardized data collection are required to explore potential differences between subgroups of nonincidental PTMC.

PMID:
24828487
DOI:
10.1210/jc.2013-2118
[Indexed for MEDLINE]

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