Impact of primary surgery on outcome in 300 patients with pathologic tumor-node-metastasis stage III papillary thyroid carcinoma treated at one institution from 1940 through 1989

Background. The pathologic tumor-node-metastasis (pTNM) system is universal ly used to define the extent of disease in human malignancies. This study e valuated the impact of initial therapy on cause-specific mortality (CSM) ra tes and recurrence rates in pTNM stage III papillary thyroid carcinoma. Methods. Three hundred patients (median age, 58 years) were followed on ave rage for 14 postoperative years. Of these, 246 patients (82%) had complete primary tumor resection; 208 patients (69%) had nodal metastases; 161 (54%) had locally invasive primary tumors; 45 patients (15%) underwent initial u nilateral lobectomy (UL). Bilateral lobar resection (BLR) accounted for 242 patients (near-total, 54%; total thyroidectomy, 23%). Results. The 30-year rates for CSM, distant metastases, nodal metastases, a nd local recurrence (LR) were 29%, 22%, 19%, and 16%, respectively. The 20- year rates for CSM were significantly, higher (50% vs 14%) when primary tum or was incompletely resected (P = .0001). lifter complete resection, 20-yea r rates for CSM and LR after BLR were 12% and 10%, respectively, which were significantly lower (P < .05) than the 23% and 26% rates seen after UL. Th ere were no significant differences in nodal metastases or distant metastas es rates between UL and BLR (P > .4). The 20-year LR rate after total thyro idectomy (13%) was not different (P = .5) from the 11% seen after near-tota l thyroidectomy. Conclusions. In this nonrandomized evaluation of patients with pTNM stage I II papillary thyroid carcinoma, the extent of primary thyroid resection app eared to significantly impact CSM and LR but did not apparently influence r egional or distant metastasis.