Microscopic positive margins strongly predict reduced disease-free survival in pT4a papillary thyroid cancer

Earl Abraham*, David Roshan, Bryan Tran, Susannah Graham, Christopher Lehane, James Wykes, Peter Campbell, Ardalan Ebrahimi

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Although microscopic positive margins appear to have no independent prognostic impact in papillary thyroid cancer (PTC), this may not be the case in pT4a tumors. Methods: Retrospective analysis of 610 patients with PTC, 39 with pT4a tumors, to determine if microscopic positive margins impact disease-free survival (DFS) in pT4a PTC. Results: On univariate analysis, microscopic positive margins were not associated with reduced DFS in patients with no extrathyroidal extension (ETE) (hazard ratio [HR], 1.7; P = 0.32), microscopic ETE (HR, 1.6; P = 0.36), or macroscopic ETE limited to strap muscles (HR, 1.2; P = 0.87). In contrast, microscopic positive margins were associated with reduced DFS in T4a disease (HR, 4.1; P = 0.04). Disease recurrence was nodal, distant, or biochemical, and did not occur directly at the site of positive margins. Conclusion: Although microscopic positive margins do not influence DFS in the majority of patients with PTC, they are associated with a fourfold increased risk of recurrence in pT4a disease.

Original languageEnglish
Pages (from-to)2549-2554
Number of pages6
JournalHead and Neck
Volume41
Issue number8
DOIs
Publication statusPublished - 1 Aug 2019

Keywords

  • aerodigestive tract
  • extrathyroidal extension
  • papillary carcinoma
  • positive margins
  • radioactive iodine
  • thyroid cancer

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