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Head Neck. 2019 Mar 12. doi: 10.1002/hed.25730. [Epub ahead of print]

Microscopic positive margins strongly predict reduced disease-free survival in pT4a papillary thyroid cancer.

Author information

1
Department of Head and Neck Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.
2
Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
3
Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
4
Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.
5
Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australia.

Abstract

BACKGROUND:

Although microscopic positive margins appear to have no independent prognostic impact in papillary thyroid cancer (PTC), this may not be the case in pT4a tumors.

METHODS:

Retrospective analysis of 610 patients with PTC, 39 with pT4a tumors, to determine if microscopic positive margins impact disease-free survival (DFS) in pT4a PTC.

RESULTS:

On univariate analysis, microscopic positive margins were not associated with reduced DFS in patients with no extrathyroidal extension (ETE) (hazard ratio [HR], 1.7; P = 0.32), microscopic ETE (HR, 1.6; P = 0.36), or macroscopic ETE limited to strap muscles (HR, 1.2; P = 0.87). In contrast, microscopic positive margins were associated with reduced DFS in T4a disease (HR, 4.1; P = 0.04). Disease recurrence was nodal, distant, or biochemical, and did not occur directly at the site of positive margins.

CONCLUSION:

Although microscopic positive margins do not influence DFS in the majority of patients with PTC, they are associated with a fourfold increased risk of recurrence in pT4a disease.

KEYWORDS:

aerodigestive tract; extrathyroidal extension; papillary carcinoma; positive margins; radioactive iodine; thyroid cancer

PMID:
30860642
DOI:
10.1002/hed.25730

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