title: Prognostic impact of extrathyroid extension and clinical lymph node metastasis in papillary thyroid carcinoma depend on carcinoma size.
abstract: BACKGROUND
  Although papillary thyroid carcinoma (PTC) generally has an indolent nature, massive extrathyroid extension (Ex) and clinical lateral node metastasis (N1b) are prominent predictors of a dire prognosis. However, it remains unknown whether these factors affect patient prognosis with uniformity. In this study, we investigated the relationships between the prognostic impact of these factors and carcinoma size.
  
  
  METHODS
  A total of 5,917 patients who underwent initial and curative surgery for PTC between 1987 and 1995 were enrolled in this study. After dividing these patients into four subsets based on tumor size--≦1.0 cm, 1.1-2.0 cm, 2.1-3.0 cm, and >3.0 cm--we investigated the prognostic impacts of Ex and N1b in each subset.
  
  
  RESULTS
  Relative risk (RR) of disease-free survival (DFS) of N1b was the highest in the subset ≦1.0 cm and decreased with tumor size. RR of Ex was smaller in carcinoma ≦3.0 cm but larger in carcinoma >3.0 cm compared with that of N1b in the respective subsets. On multivariate analysis, N1b was a more important prognostic factor than Ex in carcinoma ≦3.0 cm, but the prognostic impacts of these two factors were reversed in carcinoma >3.0 cm. Similar findings were obtained in analyses for cause-specific survival (CSS) and prognostic value of N1b was more significant in carcinoma ≦3.0 cm but less significant in carcinoma >3.0 cm than that of Ex.
  
  
  CONCLUSIONS
  The prognostic values of Ex and N1b vary with tumor size in PTC. It is important for physicians to pay attention to tumor size when evaluating the prognostic impact of these two prominent factors.
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan. mitch@hot.jp
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fukushima
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Hirokawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miya
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimizu
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology*; D000328:Adult; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology*
references.citation: Cancer. 1991 Jul 15;68(2):324-30
references.pmid: 2070332
references.citation: J Surg Oncol. 1998 Aug;68(4):237-41
references.pmid: 9721709
references.citation: World J Surg. 2005 Jul;29(7):917-20
references.pmid: 15951927
references.citation: Cancer. 1985 Feb 15;55(4):805-28
references.pmid: 3967175
references.citation: Thyroid. 1995 Feb;5(1):25-8
references.pmid: 7787429
references.citation: World J Surg. 2006 May;30(5):780-6
references.pmid: 16411013
references.citation: Surgery. 1988 Dec;104(6):947-53
references.pmid: 3194846
references.citation: Endocr J. 1999 Feb;46(1):91-8
references.pmid: 10426572
references.citation: Endocr J. 2009;56(2):177-92
references.pmid: 18703852
references.citation: Int Surg. 1990 Oct-Dec;75(4):220-4
references.pmid: 2292479
references.citation: World J Surg. 2007 Apr;31(4):838-48
references.pmid: 17347900
references.citation: Med Klin (Munich). 1991 Feb 15;86(2):76-82
references.pmid: 2030663
references.citation: Surgery. 2004 Feb;135(2):139-48
references.pmid: 14739848
references.citation: Chirurg. 1996 Aug;67(8):788-806
references.pmid: 8964151
references.citation: Surgery. 1993 Dec;114(6):1050-7; discussion 1057-8
references.pmid: 8256208
references.citation: Br J Surg. 1995 Aug;82(8):1092-4
references.pmid: 7648162
references.citation: Virchows Arch A Pathol Anat Histol. 1982;396(1):19-39
references.pmid: 7123844
references.citation: Surg Today. 2006;36(1):12-8
references.pmid: 16378187
references.citation: World J Surg. 2007 Nov;31(11):2085-91
references.pmid: 17885787
references.citation: World J Surg. 2005 Apr;29(4):483-5
references.pmid: 15776292
references.citation: Eur J Surg. 1992 Nov-Dec;158(11-12):583-9
references.pmid: 1363062
references.citation: Cancer. 1997 Nov 1;80(9):1803-4
references.pmid: 9351551
references.citation: World J Surg. 1994 Jul-Aug;18(4):559-67; discussion 567-8
references.pmid: 7725745
references.citation: Am J Med. 1981 Mar;70(3):511-8
references.pmid: 7211893