Abstract
Introduction Differentiated thyroid cancer (DTC) has an overall excellent prognosis. Patients who develop recurrent disease have a more unfavorable disease course than those with no recurrence. Higher recurrence rates are seen with incomplete surgical resection and gross positive margins. It is unclear whether microscopic positive margin affects disease recurrence rates as much as grossly positive margin. Aim of the Study. To assess whether microscopic positive margin is an independent predictor of disease recurrence in patients with overall low-risk DTC. Patients and Methods. We conducted a retrospective single-center institutional review of 1,583 consecutive patients' charts from 1995–2013 using the Canadian Thyroid Cancer Consortium Registry. We included adult patients with nonmetastasizing T1 and T2 DTC with a minimum of three years follow-up. Univariate and multivariate analyses were used to study factors that may influence the risk of persistent/recurrent disease. Strict definitions of persistent versus recurrent disease were applied. Results 963 patients (152 men and 811 women) were included in the study with a mean age of 46 years. Microscopic positive margins were present in 12% of the specimens and were associated with an increased rate of persistent disease (8% versus 2% in the controls) but not with an increased risk of recurrent disease (1% in both groups). T2 tumors had a significantly higher incidence of positive margins than T1 tumors (48% versus 36%) and significantly higher nodal staging. Conclusions Microscopic positive margin in the histopathology report in patients with low-risk DTC was associated with a higher rate of persistent disease but did not increase the risk of disease recurrence. A close follow-up of biomarkers and occult residual cancerous lesions is needed, especially in the first year. Further studies are needed to determine whether additional therapeutic measures to prevent recurrence are indicated in T1 and T2 DTC with positive microscopic surgical margins.
Highlights
Differentiated thyroid cancer (DTC) has an overall excellent prognosis
In patients who had undergone total thyroidectomy for T1T2 DTC, we found that microscopic positive margins were present in 12% of the specimens. is was associated with an increased rate in persistent disease but not with an increased risk of disease recurrence
Sapuppo et al [13] emphasized the importance of this distinction and de ned each disease status separately. ey concluded that patients with DTC who are not cured after initial treatment are more prone to have persistent disease and have worse outcomes than recurrent disease
Summary
Differentiated thyroid cancer (DTC) has an overall excellent prognosis. Patients who develop recurrent disease have a more unfavorable disease course than those with no recurrence. To assess whether microscopic positive margin is an independent predictor of disease recurrence in patients with overall low-risk DTC. Microscopic positive margins were present in 12% of the specimens and were associated with an increased rate of persistent disease (8% versus 2% in the controls) but not with an increased risk of recurrent disease (1% in both groups). Microscopic positive margin in the histopathology report in patients with low-risk DTC was associated with a higher rate of persistent disease but did not increase the risk of disease recurrence. Recurrence of thyroid cancer is not unusual and occurs in 2 to 20% of patients, depending on the study cohort, disease staging, and variations in definitions of recurrence versus persistent disease [5,6,7]. It is well known that patients who develop recurrent disease after curative treatment have a higher probability of death resulting from thyroid cancer [3]. erefore, it is imperative to stratify risk and to identify patients who are more prone to recurrence as this could potentially affect clinical management.
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