Prognosis of Patients with Papillary Thyroid Carcinoma Showing Postoperative Recurrence to the Central Neck

Background The prognosis and prognostic factors of papillary carcinoma have been intensively investigated. However, details of patient prognosis after the detection of recurrence remain unclear. In this study, we investigated the prognosis of papillary carcinoma patients after showing recurrence in the central neck. Methods We enrolled 403 patients who underwent initial, locally curative surgery for papillary carcinoma in Kuma Hospital between 1987 and 2004 and then showed recurrence in the central neck during follow-up. Results The 5- and 10-year cause-specific survival (CSS) rates for patients after initial recurrence to the lymph node were 95 and 88%, respectively. Age > 45 years at recurrence and some clinicopathologic features at the initial surgery-aggressive histology, tumor > 4 cm, lymph node metastasis > 3 cm, significant extrathyroid extension-affected the CSS of patients. Except for extrathyroidal extension, these features were independent prognostic factors on a multivariate analysis. Patients initially showing recurrence to subcutaneous tissue suspected of needle tract implantation during fine-needle aspiration biopsy and those showing recurrence to the remnant thyroid demonstrated an excellent prognosis; none of these patients died of carcinoma during follow-up. The prognosis of patients showing initial recurrence to the thyroid bed or perithyroid tissue was significantly worse than that of those with initial recurrence to the lymph node; their 5- and 10-year CSS rates were 88 and 79%, respectively. Conclusions Aggressive histology, the size of the primary lesion and of the lymph node metastasis, and age at recurrence independently affected the prognosis of patients showing initial recurrence to the lymph node. Prognoses of patients with recurrence to the subcutaneous tissue or remnant thyroid were excellent. However, patients initially showing recurrence to the thyroid bed or perithyroid tissue exhibited a worse prognosis; and careful second surgery and subsequent follow-up are thus mandatory.