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Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015

Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country. A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therape...

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Autores principales: Czarniecka, Agnieszka, Zeman, Marcin, Wozniak, Grzegorz, Maciejewski, Adam, Stobiecka, Ewa, Chmielik, Ewa, Oczko-Wojciechowska, Malgorzata, Krajewska, Jolanta, Handkiewicz-Junak, Daria, Jarzab, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450606/
https://www.ncbi.nlm.nih.gov/pubmed/34552559
http://dx.doi.org/10.3389/fendo.2021.718833
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author Czarniecka, Agnieszka
Zeman, Marcin
Wozniak, Grzegorz
Maciejewski, Adam
Stobiecka, Ewa
Chmielik, Ewa
Oczko-Wojciechowska, Malgorzata
Krajewska, Jolanta
Handkiewicz-Junak, Daria
Jarzab, Barbara
author_facet Czarniecka, Agnieszka
Zeman, Marcin
Wozniak, Grzegorz
Maciejewski, Adam
Stobiecka, Ewa
Chmielik, Ewa
Oczko-Wojciechowska, Malgorzata
Krajewska, Jolanta
Handkiewicz-Junak, Daria
Jarzab, Barbara
author_sort Czarniecka, Agnieszka
collection PubMed
description Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country. A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-up MATERIAL: Our prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed. RESULTS: Only 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7(th) edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism. SUMMARY: The results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient.
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spelling pubmed-84506062021-09-21 Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015 Czarniecka, Agnieszka Zeman, Marcin Wozniak, Grzegorz Maciejewski, Adam Stobiecka, Ewa Chmielik, Ewa Oczko-Wojciechowska, Malgorzata Krajewska, Jolanta Handkiewicz-Junak, Daria Jarzab, Barbara Front Endocrinol (Lausanne) Endocrinology Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country. A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-up MATERIAL: Our prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed. RESULTS: Only 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7(th) edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism. SUMMARY: The results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient. Frontiers Media S.A. 2021-09-06 /pmc/articles/PMC8450606/ /pubmed/34552559 http://dx.doi.org/10.3389/fendo.2021.718833 Text en Copyright © 2021 Czarniecka, Zeman, Wozniak, Maciejewski, Stobiecka, Chmielik, Oczko-Wojciechowska, Krajewska, Handkiewicz-Junak and Jarzab https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Czarniecka, Agnieszka
Zeman, Marcin
Wozniak, Grzegorz
Maciejewski, Adam
Stobiecka, Ewa
Chmielik, Ewa
Oczko-Wojciechowska, Malgorzata
Krajewska, Jolanta
Handkiewicz-Junak, Daria
Jarzab, Barbara
Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title_full Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title_fullStr Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title_full_unstemmed Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title_short Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015
title_sort therapeutic strategy in low-risk papillary thyroid carcinoma – long-term results of the first single-center prospective non-randomized trial between 2011 and 2015
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450606/
https://www.ncbi.nlm.nih.gov/pubmed/34552559
http://dx.doi.org/10.3389/fendo.2021.718833
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