医学
回顾性队列研究
甲状腺切除术
危险系数
甲状旁腺机能减退
外科
风险因素
队列
甲状腺
甲状腺癌
内科学
置信区间
作者
Hyemi Kwon,Min Ji Jeon,Won Gu Kim,Suyeon Park,Mijin Kim,Dong Eun Song,Tae‐Yon Sung,Jong Ho Yoon,Suck Joon Hong,Tae Yong Kim,Young Kee Shong,Won Kim
出处
期刊:European journal of endocrinology
[Bioscientifica]
日期:2017-04-01
卷期号:176 (4): 371-378
被引量:73
摘要
Objective Papillary thyroid microcarcinoma (PTMC) accounts for most of the increase in thyroid cancer in recent decades. We compared clinical outcomes and surgical complications of lobectomy and total thyroidectomy (TT) in PTMC patients. Design and methods In this retrospective individual risk factor-matched cohort study, 2031 patients with PTMC were initially included. Patients who underwent lobectomy or TT were one-to-one matched according to individual risk factors, including age, sex, primary tumor size, extrathyroidal extension, multifocality and cervical lymph node (LN) metastasis. Results In total, 688 patients were assigned to each group. During the median 8.5 years of follow-up, 26 patients (3.8%) in the lobectomy group and 11 patients (1.6%) in the TT group had recurrences. The relative risk of recurrence was significantly less in the TT than that in the lobectomy group (hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.21–0.81; P = 0.01). Most recurrences (84.6%) in the lobectomy group occurred in the contralateral lobe, and all patients were disease-free after completion of thyroidectomy. There were no significant differences in recurrence-free survival between the two groups after exclusion of contralateral lobe recurrences (HR, 2.75; 95% CI, 0.08–8.79; P = 0.08). There were significantly more patients with transient and permanent hypoparathyroidism in the TT than that in the lobectomy group ( P < 0.001). Conclusions Lobectomy could be appropriate for most patients with PTMC when there is no evidence of extrathyroidal disease in the preoperative work-up. Preoperative and postoperative imaging studies are important for patients who undergo lobectomy for PTMC, because most recurrences are in the contralateral lobe.
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