Differences in the recurrence and mortality outcomes rates of incidental and nonincidental papillary thyroid microcarcinoma: a systematic review and meta-analysis of 21 329 person-years of follow-up.
BACKGROUND
There is controversy as to whether papillary thyroid microcarcinoma (PTMC) represents more than one disease entity with different outcomes, requiring different treatment.


OBJECTIVE
To compare characteristics, outcomes, and factors associated with prognosis of incidental and nonincidental PTMC.


METHODS
Two reviewers performed searches of online databases (1966-2012), reference lists, and conference abstract books. Longitudinal studies of subjects >16 years old receiving any treatments for papillary thyroid cancer ≤10 mm in size were included. Two reviewers independently screened abstracts and articles, extracted data, and assessed quality of studies using National Institute of Clinical Excellence and PRISMA criteria.


RESULTS
Of 1102 abstracts identified, 262 studies were reviewed and 17 studies included, comprising 3523 subjects, with mean follow-up of 70 months and total follow-up of 21 329 person-years. This included 854 subjects with incidental PTMC (follow-up, 4800 person-years; mean tumor size, 4.6 mm [range 3.3-6.7 mm]) and 2669 nonincidental PTMC cases (follow-up, 16 529 person-years; mean tumor size, 6.9 mm [range 5.6-8.0 mm]). The recurrence rate in the incidental group (0.5%; 95% confidence interval [CI], 0-1%, P < .001) was significantly lower than that in the nonincidental group PTMC (7.9%; 95% CI, 5-11%), with an OR of recurrence of 14.7 (95% CI, 5.6-54.8, P < .001) for nonincidental PTMC, compared with incidental PTMC. Lymph nodes were involved in 80% (126/157) of recurrences. On meta-regression, age, sex, size, tumor multifocality, lymph node involvement, and treatment modality were not significantly associated with recurrence.


CONCLUSIONS
Our meta-analysis strongly suggests the existence of at least two distinct entities of PTMC. Incidental PTMC has different clinical characteristics and a much lower recurrence rate than nonincidental PTMC, suggesting that management protocols should be re-considered. Additional studies with standardized data collection are required to explore potential differences between subgroups of nonincidental PTMC.
Institute of Head and Neck Studies and Education, School of Cancer Sciences (H.M., T.A., N.C.), University of Birmingham, Birmingham B15 2TT, United Kingdom; Cancer Research Clinical Trials Unit, School of Cancer Sciences (B.C., E.M.), University of Birmingham, Birmingham B15 2TT, United Kingdom; University Hospitals Birmingham NHS Foundation Trust (J.W.), University of Birmingham, Birmingham B15 2TT, United Kingdom; and School of Clinical and Experimental Medicine (C.M., K.B., J.A.F.), University of Birmingham, Birmingham B15 2TT, United Kingdom.
Hisham
H
Mehanna
Taleb
T
Al-Maqbili
Ben
B
Carter
Emma
E
Martin
Nicholas
N
Campain
John
J
Watkinson
Chris
C
McCabe
Kristien
K
Boelaert
Jayne A
JA
Franklyn
D000328:Adult; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy