Thyroid Lobectomy and Neck Dissection for N1b Papillary Thyroid Carcinoma

Area of Science:

• Endocrinology
• Oncology
• Surgical Oncology

Background:

• Papillary thyroid carcinoma (PTC) with lateral neck metastases (N1b) is typically managed with total thyroidectomy (TT), neck dissection, and radioactive iodine (RAI).
• This aggressive treatment approach carries higher risks of complications compared to thyroid lobectomy (TL) and neck dissection.
• Limited data exists comparing outcomes between TL and TT + RAI for N1b PTC patients in Western populations.

Purpose of the Study:

• To compare recurrence and survival outcomes between propensity-matched patients who underwent TL versus TT + RAI for ipsilateral N1b PTC.
• To evaluate the efficacy and safety of TL as an alternative treatment for select N1b PTC cases.

Main Methods:

• A propensity-matched cohort study was conducted at a single US tertiary cancer center.
• The study included 37 patients treated with TL and 37 patients treated with TT + RAI, selected from a database of 598 patients with N1b PTC (1986-2020).
• Exclusion criteria included M1 disease; median follow-up was 90-113 months.

Main Results:

• Five-year overall survival (OS) was 96.9% for TL and 96.8% for TT + RAI (HR 0.2).
• Five-year disease-specific survival (DSS) was 96.7% for TL and 100% for TT + RAI.
• Five-year recurrence-free survival (RFS) was 89.8% for TL and 88.9% for TT + RAI (HR 1.48). Survival rates remained stable between 5 and 10 years.

Conclusions:

• Thyroid lobectomy (TL) demonstrated comparable survival and recurrence outcomes to total thyroidectomy (TT) plus radioactive iodine (RAI) in carefully selected patients with N1b PTC.
• TL is a viable and safe treatment option for N1b PTC patients with unilateral tumors, low-volume lymph node metastases, and no extranodal extension.
• These findings support individualized treatment strategies for N1b PTC, considering patient selection and counseling.