A 29-year retrospective review of papillary thyroid cancer in one institution

Objective: The goal of this study was to determine whether conservative surgical therapy had been adequate for low-risk patients with papillary thyroid cancer. Study design and patients: 1,931 patients were categorized as either low risk or high risk, using tumor-node-metastasis (TNM) staging from the sixth edition of International Union Against Cancer (UICC); TNM stage I was designated low risk during this retrospective review. Main outcomes: After an average follow-up period of 8.7 years, 58 of 1,931 patients (3.0%) died from thyroid cancer. Ten-year survival rates of papillary thyroid carcinoma from sixth edition TNM stages I to IV are 99.7%, 95.6%, 90.7%, and 84.0%, respectively. Age, tumor size, ¹³¹I therapeutic dose, and follow-up status were statistically significant when comparing high- and low-risk groups. Of the 1,432 patients in stage I, 338 underwent conservative surgical procedures. Among 338, 4 patients died of thyroid carcinomas (1.2%) and 15 (4.4%) had persistent or recurrent disease. In contrast, 2 of the 1,094 (0.2%) patients who received near-total thyroidectomy or limited lymph node dissection died from thyroid cancer, and 32 (2.9%) had persistent or recurrent disease. Conclusions: TNM stage I papillary thyroid carcinomas were with low cancer-specific mortality rate; otherwise, patients aged 45 years or younger should not be considered a homogeneous low-risk group. Initial extent of disease was an important predictor among these patients. In particular, local invasion with airway compression predicts outcomes.