Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence
For the rare but aggressive insular thyroid carcinoma (ITC), there's no clear evidence to determine whether prophylactic central compartment neck dissection (CCND) is necessary for cN0 disease. This study provides the first evidence that treating cN0 ITC without prophylactic CCND is associated...
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Wiley
2019-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2019/3078012 |
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| author | Peng-Cheng Yu Xiao Shi Ben Ma Cui-Wei Li Li-Cheng Tan Wei-Ping Hu Yu Wang Wen-Jun Wei Yu-Long Wang Qing-Hai Ji |
| author_facet | Peng-Cheng Yu Xiao Shi Ben Ma Cui-Wei Li Li-Cheng Tan Wei-Ping Hu Yu Wang Wen-Jun Wei Yu-Long Wang Qing-Hai Ji |
| author_sort | Peng-Cheng Yu |
| collection | DOAJ |
| description | For the rare but aggressive insular thyroid carcinoma (ITC), there's no clear evidence to determine whether prophylactic central compartment neck dissection (CCND) is necessary for cN0 disease. This study provides the first evidence that treating cN0 ITC without prophylactic CCND is associated with decreased survival regardless of T staging and administration of RAI therapy. Background. Regarding the rare but aggressive insular thyroid carcinoma (ITC), the value of prophylactic central compartment neck dissection (CCND) for clinically node-negative (cN0) disease is unclear. We aimed to provide the first evidence. Methods. N0 and pN1a ITC patients were identified from the Surveillance, Epidemiology, and End Results database. These patients were divided into thyroid-surgery + CCND group (pN0/pN1a patients confirmed by CCND) and thyroid-surgery group (cN0 patients without CCND). Differences in overall survival (OS) and disease-specific survival (DSS) between the two groups were evaluated. Subgroup analyses were also conducted. Results. Of the overall 112 patients, 44 (39.3%) received CCND. On multivariate analyses, the lobectomy ± isthmusectomy/total-thyroidectomy (Lob/TT) group demonstrated poorer OS and DSS than the Lob/TT + CCND group (P<0.05). When we separately analyzed patients treated by TT, multivariate analyses showed the TT group still revealed compromised OS and DSS than the TT + CCND group (P<0.05). Furthermore, absence of CCND independently predicted decreased OS no matter whether radioactive iodine (RAI) was administered. Similar results were obtained for T3/T4 patients. Moreover, for T1/T2 patients receiving CCND, 0/12 died during the study period, while for T1/T2 patients without CCND, 8/23 (34.8%) died, 5/23 (21.7%) due to ITC. Conclusion. Regardless of T staging and RAI treatment, cN0-ITC patients without CCND had decreased survival compared with pN0/pN1a patients receiving CCND. Therefore, if a cN0 patient is diagnosed with ITC, prophylactic CCND may be considered as a secondary procedure (postoperatively diagnosed) or a primary procedure (preoperatively/intraoperatively diagnosed). Prospective studies are expected to validate the conclusion. |
| format | Article |
| id | doaj-art-53ddb37a541a46b6bc4c8bcd1722e10f |
| institution | OA Journals |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
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| series | International Journal of Endocrinology |
| spelling | doaj-art-53ddb37a541a46b6bc4c8bcd1722e10f2025-08-20T02:05:24ZengWileyInternational Journal of Endocrinology1687-83371687-83452019-01-01201910.1155/2019/30780123078012Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First EvidencePeng-Cheng Yu0Xiao Shi1Ben Ma2Cui-Wei Li3Li-Cheng Tan4Wei-Ping Hu5Yu Wang6Wen-Jun Wei7Yu-Long Wang8Qing-Hai Ji9Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, ChinaFor the rare but aggressive insular thyroid carcinoma (ITC), there's no clear evidence to determine whether prophylactic central compartment neck dissection (CCND) is necessary for cN0 disease. This study provides the first evidence that treating cN0 ITC without prophylactic CCND is associated with decreased survival regardless of T staging and administration of RAI therapy. Background. Regarding the rare but aggressive insular thyroid carcinoma (ITC), the value of prophylactic central compartment neck dissection (CCND) for clinically node-negative (cN0) disease is unclear. We aimed to provide the first evidence. Methods. N0 and pN1a ITC patients were identified from the Surveillance, Epidemiology, and End Results database. These patients were divided into thyroid-surgery + CCND group (pN0/pN1a patients confirmed by CCND) and thyroid-surgery group (cN0 patients without CCND). Differences in overall survival (OS) and disease-specific survival (DSS) between the two groups were evaluated. Subgroup analyses were also conducted. Results. Of the overall 112 patients, 44 (39.3%) received CCND. On multivariate analyses, the lobectomy ± isthmusectomy/total-thyroidectomy (Lob/TT) group demonstrated poorer OS and DSS than the Lob/TT + CCND group (P<0.05). When we separately analyzed patients treated by TT, multivariate analyses showed the TT group still revealed compromised OS and DSS than the TT + CCND group (P<0.05). Furthermore, absence of CCND independently predicted decreased OS no matter whether radioactive iodine (RAI) was administered. Similar results were obtained for T3/T4 patients. Moreover, for T1/T2 patients receiving CCND, 0/12 died during the study period, while for T1/T2 patients without CCND, 8/23 (34.8%) died, 5/23 (21.7%) due to ITC. Conclusion. Regardless of T staging and RAI treatment, cN0-ITC patients without CCND had decreased survival compared with pN0/pN1a patients receiving CCND. Therefore, if a cN0 patient is diagnosed with ITC, prophylactic CCND may be considered as a secondary procedure (postoperatively diagnosed) or a primary procedure (preoperatively/intraoperatively diagnosed). Prospective studies are expected to validate the conclusion.http://dx.doi.org/10.1155/2019/3078012 |
| spellingShingle | Peng-Cheng Yu Xiao Shi Ben Ma Cui-Wei Li Li-Cheng Tan Wei-Ping Hu Yu Wang Wen-Jun Wei Yu-Long Wang Qing-Hai Ji Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence International Journal of Endocrinology |
| title | Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence |
| title_full | Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence |
| title_fullStr | Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence |
| title_full_unstemmed | Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence |
| title_short | Treating Clinically Node-Negative Insular Thyroid Carcinoma without Prophylactic Central Compartment Neck Dissection Is Associated with Decreased Survival Regardless of T Staging and Administration of Radioactive Iodine Therapy: The First Evidence |
| title_sort | treating clinically node negative insular thyroid carcinoma without prophylactic central compartment neck dissection is associated with decreased survival regardless of t staging and administration of radioactive iodine therapy the first evidence |
| url | http://dx.doi.org/10.1155/2019/3078012 |
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