J.Jpn. Surg. Soc.. 124(1): 18-24, 2023

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Feature topic

MANAGEMENT STRATEGY FOR PAPILLARY THYROID CARCINOMA ACCORDING TO RISK CLASSIFICATION

Although the prognosis of papillary thyroid carcinoma (PTC) is generally favorable, a portion of cases becomes life-threatening after carcinoma recurrence. In this paper, prognostic factors based on pre- and intraoperative findings are described. Age is an important prognostic factor: young patients are likely to recur and old patients are likely to recur and die of carcinoma. The risk classification of the Clinical Practice Guidelines on the Management of Thyroid Tumors of the Japan Association of Endocrine Surgery classified PTC into four categories:1) very low-risk, T1aN0M0; 2) low-risk, T1bN0M0; 3) high-risk, tumor size >4 cm, significant extrathyroid or extranodal tumor extension, node metastasis >3 cm, and distant metastasis at diagnosis; and 4) intermediate-risk, not belonging to the other three. Very low/low-risk patients showed a favorable prognosis regardless of age. Old patients (≥55 years) showed a poorer prognosis than young patients in the intermediate- and high-risk categories, and the prognosis of old intermediate-risk patients did not differ from that of young high-risk patients. Aggressive therapy should not be performed for very low/low-risk patients. For old high-risk patients, therapeutic strategies should be considered based on cognitive function, general condition, and performance status.

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