A high Ki‐67 labeling index and high thyroglobulin doubling rate are significant predictors of excision‐site recurrence of papillary thyroid carcinoma following airway resection for locally curative surgery.

Background: Papillary thyroid carcinoma (PTC) occasionally invades the trachea and requires airway resection. Tracheal excision site recurrence (ESR) is a serious problem. We investigated predictors of ESR in patients with PTC who underwent airway resection for locally curative surgery. Methods: We enrolled 149 patients with PTC who underwent airway resection (median age at the initial surgery: 67 years), including partial‐thickness resection (n = 73) or full‐thickness resection (n = 76), for grossly curative surgery. The median postoperative follow‐up period was 93 months. Results: To date, 11 patients (6.7%) underwent ESR: 6 underwent full‐thickness resection and 5 underwent partial‐thickness resection. The time to ESR ranged from 14 to 113 months (median: 57 months) after the initial surgery. None of the 11 ESR patients underwent adjuvant external beam radiotherapy (EBRT) and none of the 4 airway resection patients who underwent EBRT developed ESR. The 5‐ and 10‐year ESR rates were 4.3% and 11.3%, respectively. In the multivariate analysis (forward–backward stepwise selection method), a Ki‐67 labeling index (LI) ≥5% (p = 0.048) and the thyroglobulin doubling rate (Tg‐DR) >0.33/year (p = 0.009) (for Tg‐antibody negative cases) were independent predictors of ESR. Nine of the 11 patients underwent ESR resection and only one developed a second recurrence. Conclusions: A high Ki‐67 LI was a static predictor, and high Tg‐DR was a dynamic predictor, of ESR in patients with PTC following airway resection. In such patients, careful postoperative monitoring for ESR is necessary and adjuvant therapies, such as EBRT, may be considered. [ABSTRACT FROM AUTHOR]