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. [ABSTRACT FROM AUTHOR]