title: Differences in the Recurrence and Survival of Patients with Symptomatic and Asymptomatic Papillary Thyroid Carcinoma: An Observational Study of 11,265 Person-Years of Follow-Up.
abstract: Papillary thyroid carcinoma (PTC) generally has an indolent course and favorable prognosis. However, an optimal treatment strategy for asymptomatic PTC is not clear. We compared the recurrence and survival outcomes of patients with asymptomatic and symptomatic PTC and identified the associated risk factors.
  
  
  
  Patients with previously untreated PTC of size ≤2 cm and who underwent curative surgery were included in this analysis. Asymptomatic PTC was defined as a tumor detected only by ultrasonography, computed tomography (CT), magnetic resonance imaging, and/or18F-fluorodeoxyglucose positron emission tomography/CT. Clinical factors, operative and pathologic findings, and posttreatment outcomes were compared between the aforementioned two groups. Univariate and multivariate analyses were performed to identify the factors associated with recurrence-free survival (RFS) and overall survival (OS).
  
  
  
  Out of 1419 patients, 1259 patients (88.7%) were asymptomatic. Patients with symptomatic PTC had significantly larger tumor size, palpability, extrathyroidal extension, high tumor and node stages, and were more likely to undergo treatment with radioactive iodine therapy compared with patients with asymptomatic PTC (p < 0.05 each). Recurrence was significantly higher in the symptomatic PTC group than in the asymptomatic group (p < 0.001). Asymptomatic PTC was an independent predictor of RFS and OS and had higher five-year rates than those associated with symptomatic tumors: 97.3% and 90.6% for RFS (p < 0.001) and 99.4% and 96.9% for OS (p < 0.001), respectively.
  
  
  
  Symptomatic PTC is associated with higher recurrence and lower overall survival rates than asymptomatic PTC. Symptomatic PTC may require total thyroidectomy and close posttreatment surveillance.
authors.affiliation: 1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Kim
authors.affiliation: 1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.affiliation: 2 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Gyungyup
authors.initials: G
authors.lastname: Gong
authors.affiliation: 2 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: 1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: 1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.affiliation: 1 Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases / Q000453:epidemiology; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects; D047368:Tumor Burden; D055815:Young Adult