1. 腫瘤大小作為甲狀腺癌手術範圍的決定因子 Tumor size as a determinant of the extent of surgery in thyroid cancer
郭其毓 劉建良 劉滄柏 林鉷彬 柯文清 鄭世平
蔡家騏 何恭誠
Chi-Yu Kuo, Chien-Liang Liu, Tsang-Pai Liu, Hung-Bun Lam, Wen-Ching Ko, Shih-Ping Cheng, Chia-Chi Tsai, Kung-Chen Ho
馬偕紀念醫院及馬偕醫學院 一般外科
Department of Surgery, Mackay Memorial Hospital and
Mackay Medical College, Taipei, Taiwan

2. Earlier Guideline NCDB: total thyroidectomy for PTC ≥ 1 cm
Lower recurrence rates
Improved survival
ATA Guideline (2009)
For thyroid cancer >1 cm:
Near-total or total thyroidectomy

3. Updated Guideline SEER and updated NCDB
Total thyroidectomy was NOT associated with a survival benefit for tumors of 1-4 cm, particularly among young patients
ATA Guideline (2015)
Thyroid cancer >1 cm and <4 cm:
Bilateral procedure (near-total or total thyroidectomy) or a unilateral procedure (lobectomy)

4. Whether there is a tumor size “threshold” for total thyroidectomy
which may minimize the rate of completion thyroidectomy?

5. Patients and Methods From 2008 to 2017 Mackay Memorial Hospital
All patients undergoing curative-intent thyroidectomy for differentiated thyroid cancer

6. Total Thyroidectomy 1. Maximum tumor size greater than 4 cm
2. Preoperative evidence of extrathyroidal extension
3. Clinically apparent lymph node metastasis
4. Presence of distant metastasis
The remaining patients were treated with either lobectomy or total thyroidectomy

7. The Need for Completion Thyroidectomy
Aggressive histology
Extrathyroidal extension
Lymphovascular invasion
Non-low risk nodal metastasis

8. Results 771 patients (from 2008 to 2017) Age: 47 ± 13 years
Gender: 630 (82%) were female
Tumor size: 1.9 ± 1.3 cm (median, 1.6 cm)
Papillary thyroid cancer: 737 (96%)
BRAF V600E mutation: 74% cases of PTC

9. Results
155 (20%) patients definitely indicated for total thyroidectomy
616 (80%) patients initially eligible for lobectomy
170 (28%) lobectomy
446 (72%) total thyroidectomy

10. 616 patients initially eligible for lobectomy
206 (33%) lymph node metastasis
161 (78%) non-low risk metastasis

11. 273 (44%) patients were considered to have the need for completion thyroidectomy
18%
57%

12. Cumulative Risk of Requiring Completion Thyroidectomy

14. Optimal Cut-off Point Estimation (ROC curve analysis)
tumor size ≥ 1.1 cm

16. Risk of Requiring Completion Thyroidectomy
Microcarcinoma: 18% → 31%
Tumor size > 1cm and ≤ 4 cm: 57% → 65%

17. Summary The Risk of Requiring Completion Thyroidectomy
Tumor Size ≥ 1.1 cm
The presence of BRAF V600E mutation

18. Thank you for your attention