Investigating the impact of tumor location and size on the risk of recurrence for papillary thyroid carcinoma in the isthmus

Background The purpose of the study was to investigate the ability of new parameters in distinguishing high‐risk patients of recurrence from isthmic papillary thyroid carcinomas (iPTCs). Methods One hundred sixteen iPTC patients who underwent total thyroidectomy were identified from 3461 PTC patients from 2014 to 2019. Tumor margin to trachea midline distance (TTD), maximum tumor size (TS), and transverse diameter of trachea (TD) were measured on CT images. Cox proportional hazard models served to identify risk factors associated with recurrence‐free survival (RFS). The iPTC prognostic formula (IPF = TD/(TTD − TS) − TD/TTD) was evaluated to assess the prognosis. RFS was conducted between the different groups using the Kaplan–Meier analysis. The receiver operating characteristic (ROC) curve of each parameter was drawn to predict recurrence. Results Central lymph node metastasis (CLNM) and extrathyroidal invasion in iPTC were 58.6% and 31.0%, respectively. Regional recurrence occurred in 16 (13.8%) patients, and no patient died or had distant metastasis. The 3‐ and 5‐year RFS of iPTC were 87.5% and 84.5%, respectively. Gender (p = 0.001) and PLNM (prelaryngeal lymph node metastasis) (p = 0.010) in cPTC (center of iPTC located between two imaginary lines perpendicular to the surface of the skin from the most lateral points of the trachea) and non‐cPTC (iPTC patients enrolled in this study excluding cPTC) groups differed significantly. A cut‐off point of tumor size >1.1 cm and IPF ≤5.57 were established to have significant differences in prognosis (p = 0.032 and p = 0.005, respectively). Multivariate analysis showed that IPF ≤5.57 was independent prognostic factor for RFS (HR: 4.415, 95%CI: 1.118–17.431, p = 0.034). Conclusion This study indicated the association between IPF and RFS in iPTC patients and established new models to assess risk factors for recurrence pre‐operation. IPF ≤5.57 was significantly associated with poor RFS and might be promising parameters for predicting prognosis and surgical decision‐making pre‐operation. This study indicated that the previously used classification of iPTC showed no significant differences in prognosis. This is the first study to integrate the isthmic tumor position, trachea width, and tumor size to demonstrate the association between IPF and the prognosis of iPTC. IPF ≤5.57 was significantly associated with recurrence and may be promising parameters that could be used for the prognostic differentiation and preoperati