BACKGROUND Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features. METHODS Consecutive patients with PTC and at least one high-risk feature treated in 2000-2012 were included in the study. High-risk features were defined as: primary tumour larger than 4 cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis. RESULTS Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93 months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1 : 1 case-control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784). CONCLUSION Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.

中文翻译：

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高危特征的甲状腺乳头状癌肺叶切除术的远期疗​​效。

背景技术尽管高水平的证据表明，这是一种较差的策略，但不建议对具有高风险特征的甲状腺乳头状癌（PTC）进行肺叶切除术。这项研究旨在检查PTC患者的手术范围和生存率与高风险特征之间的关系。方法这项研究包括2000年至2012年接受治疗且患有PTC且具有至少一种高风险特征的连续患者。高危特征定义为：原发肿瘤大于4厘米，甲状腺外明显扩张，宏观多灶性，并证实淋巴结转移，包括病理性颈外转移（pN1b）或五个以上中央淋巴结转移。使用Cox比例风险模型在整个队列和配对分析中测量手术程度与疾病特异性生存（DSS）之间的关联。结果在2059例高危患者中，有1224例接受了肺叶切除术，其中835例接受了全甲状腺切除术。进行全甲状腺切除术的患者的双侧癌症发生率明显高于接受肺叶切除术的患者（分别为79.4和2.7％），宏观多灶性（80.8％和32.8％）和双侧颈部转移（30.9和3.3％）（所有P <0.001）。中位随访时间为93个月，多变量分析显示，在整个队列中，手术程度与DSS无关（危险比1.36，95％ci为0.75至2.48； P = 0.310）。1之后 1例病例对照匹配528例患者，在10年DSS发生率（分别为94.3％和95.2％； P = 0.323）或10年无复发生存率方面，肺叶切除术和全甲状腺切除术组之间无显着差异。 （75.8％对79.2％； P = 0.784）。结论PTC和高风险患者的肺叶切除术并没有明显恶化的预后。