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Context-Dependent Prognostic Impact of Microscopic Positive Surgical Margin in Papillary Thyroid Carcinoma
Hyungju Kwon1, Ting-Chun Kuo2,3, Michael Bouvet4,5
1Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Objective.:
Microscopic positive surgical margins (mPSMs) are identified in approximately 10% of patients with papillary thyroid carcinoma (PTC). Previous studies have reported conflicting.
Results.:
regarding the association between mPSM and recurrence risk. These discrepancies may stem, at least in part, from insufficient consideration of clinicopathological factors that modify recurrence risk.
Methods.:
This retrospective single-center study included 2,539 patients who underwent thyroidectomy for PTC between 2009 and 2023 at a tertiary referral center in Korea. Patients were stratified by nodal status into N0 (n = 1,705), N1a (n = 660), and N1b (n = 174) groups. Cox proportional hazards modeling, survival tree analysis, and random survival forest analysis were used to evaluate prognostic factors. The primary outcome was recurrence-free survival (RFS).
Results.:
mPSM was identified in 2.9% of patients in the N0 group, 4.7% in the N1a group, and 8.6% in the N1b group. During a median follow-up of 7.4 years, 74 patients (2.9%) experienced recurrence. In N0 patients, mPSM was associated with significantly reduced 5- year RFS (90.2% vs. 99.1%, p = 0.002; HR 5.513, 95% CI 1.657-18.35). However, no significant association between mPSM and recurrence was observed in either the N1a group (HR 0.960, 95% CI 0.130-7.077) or the N1b group (HR 1.466, 95% CI 0.337-6.379). Random survival forest analysis identified LN metastasis as the dominant predictor of recurrence, whereas mPSM contributed minimally to recurrence prediction overall.
Conclusion.:
The prognostic impact of mPSM in PTC appears to be context-dependent and clinically meaningful primarily in node-negative disease. Combined assessment of margin and nodal status may improve postoperative risk stratification and follow-up planning.
