J Endocr Surg.  2018 Jun;18(2):142-154. 10.16956/jes.2018.18.2.142.

Clinical Significance of Tumor Size in Papillary Thyroid Microcarcinoma: a Meta-Analysis

• Kim SJ
• Kim K
• Song YP
• Sung HK
• Lee KE
• Park SK

• KMID: 2420769
• DOI: http://doi.org/10.16956/jes.2018.18.2.142

Abstract

PURPOSE
To determine whether the tumor size associtates with aggressive clinicopathologic features and tumor recurrence in patients with papillary thyroid microcarcinoma (PTMC) who had undergone thyroidectomy. Clinical significance of tumor size in patients with PTMC is still controversial.
METHODS
A search of PubMed, MEDLINE, and EMBASE identified the clinical studies that examined the association of subgroups classified by tumor size (5 mm) in surgical specimens with aggressive clinicopathologic features, and clinical outcomes between 1976 and 2017. Seven hundred twenty relevant studies were searched, and the authors selected 34 studies, including 12,134 PTMC cases. Random effects meta-analyses were performed using odds ratios (ORs) or relative risks (RRs) with 95% confidence intervals (CIs).
RESULTS
In 34 studies, compared with the patients with small PTMC, the patients with large PTMC had a higher risk of multifocality (OR, 1.97; 95% CI, 1.61-2.40; I2, 40.7%), extrathyroidal extension (OR, 3.42; 95% CI, 2.46-4.75; I2, 64.9%), and lymph node metastasis (OR, 2.45; 95% CI, 1.79-3.37; I2, 80.5%). In 10 studies, patient with large PTMC had 1.65-fold increased risk of locoregional recurrence (95% CI, 1.20-2.27; I2, 0.0%).
CONCLUSION
This meta-analysis showed that tumor size in PTMC is associated with high-risk clinicopathologic characteristics and tumor recurrence. These findings may be helpful to decide treatment plans for patients with PTMC larger than 5 mm.

Keyword

Papillary thyroid microcarcinoma; Meta-analysis

MeSH Terms

Humans
Lymph Nodes
Neoplasm Metastasis
Odds Ratio
Recurrence
Thyroid Gland*
Thyroidectomy

Figure

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  Fig. 1. Flow chart for article selection for the meta-analysis.

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  Fig. 2. Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the high-risk factors: (A) multifocality, (B) bilaterality, (C) extrathyroidal extension, (D) LN metastasis, (E) CLN metastasis, and (F) LLN metastasis. PTMC = papillary thyroid microcarcinoma; LN = lymph node; CLN = central lymph node; LLN = lateral lymph node; OR = odds ratio; CI = confidence interval.

• 

  Fig. 2. (Continued) Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the high-risk factors: (A) multifocality, (B) bilaterality, (C) extrathyroidal extension, (D) LN metastasis, (E) CLN metastasis, and (F) LLN metastasis. PTMC = papillary thyroid microcarcinoma; LN = lymph node; CLN = central lymph node; LLN = lateral lymph node; OR = odds ratio; CI = confidence interval.

• 

  Fig. 3. Summarized statistics and corresponding forest plot on the association of large PTMC (size >5 mm) with the risk of tumor recurrence: (A) LR and (B) DM recurrence. PTMC = papillary thyroid microcarcinoma; LR = locoregional recurrence; DM = distant metastasis; RR = relative risk; CI = confidence interval.

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