Recurrence patterns and survival outcomes in advanced papillary thyroid carcinoma: a retrospective cohort analysis

Abstract Papillary thyroid carcinoma (PTC) is the most common malignant thyroid tumor, with a small proportion of patients presenting with advanced disease. The recent European Society of Endocrine Surgeons (ESES) consensus introduced a refined definition of advanced thyroid cancer. This study aimed to characterize real-world clinical features, treatment patterns, and surgical outcomes of patients with advanced PTC according to the updated ESES definition treated at a high-volume endocrine surgery center. This monocentric, retrospective cohort study included all patients who underwent primary surgery for advanced PTC at a high-volume endocrine surgery center between 2015 and 2023. Clinical data originated from our own patients in the EUROCRINE ® registry. A total of 33 patients with advanced PTC were included. Median age at diagnosis was 54 years, 52% were male, and median Charlson Comorbidity Index (CCI) was 2, indicating a low comorbidity burden. Among patients disease-free after surgery (n = 27), 11 (41%) experienced tumor recurrence, most frequently in lymph nodes and lung combined (36%) or in lymph nodes alone (27%). Median recurrence-free survival was 98 months. Patients with persistent disease after surgery had a poor prognosis, with a median progression-free survival of 4.5 months. Age > 55 years was associated with reduced overall survival ( p = 0.007), while male sex was associated with increased recurrence risk ( p = 0.047); both findings should be interpreted with caution. Despite advanced disease, most patients achieved disease-free status after primary surgery, with the majority being alive at last follow-up. Due to the limited sample size and missing follow-up data for some patients, these findings should be taken with caution, and larger studies are needed to confirm potential predictors of survival and recurrence.