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Published on: June 9, 2023
Prognostic Significance of Microscopic Positive Margin in Differentiated Thyroid Carcinoma: A Systematic Review and
Jeongshin An1,2, Hyeonuk Hwang1, Hyeji Kim3
1Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Objective.:
Microscopic positive surgical margin (mPSM) is found in around 10% of thyroid cancer cases, but it is controversial whether mPSM is associated with recurrence. This systematic review and meta-analysis integrated available evidence to clarify the association between mPSM and recurrence in differentiated thyroid carcinoma.
Methods.:
Cochrane Database of Systematic Reviews, MEDLINE/ PubMed, Web of Science Core Collection, and EMBASE were systematically searched from their inception through December 31, 2024. Three reviewers independently extracted study characteristics and hazard ratio (HR) of mPSM from included studies. The primary endpoint was cancer recurrence. Subgroup analysis of the primary outcome was conducted on the basis of margin location.
Results.:
Eleven studies comprising 20,446 patients were included in the analysis. Patients with mPSM had significantly higher recurrence rates than those with clear margins (pooled HR 1.78, 95% CI 1.43-2.20). This finding was replicated and validated when we examined 7 studies with 14,701 patients with only papillary thyroid carcinoma (pooled HR 1.87, 95% CI 1.34-2.60). Subgroup analysis revealed a markedly increased risk in cases with posterior mPSM (pooled HR 5.23, 95% CI 1.41-19.46), while anterior mPSM showed a nonsignificant association (pooled HR 1.22, 95% CI 0.82-1.82; P = 0.32).
Conclusion.:
This systematic review and meta-analysis suggests that mPSM may be associated with an increased risk of recurrence in differentiated thyroid carcinoma. Margin location may be an important factor to consider when evaluating the impact of mPSM on recurrence.
