{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:00:14Z","timestamp":1780999214807,"version":"3.54.1"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The updated American Joint Committee on Cancer (AJCC) staging system has excluded minimal extrathyroidal extension (mETE) from the T3 category. However, mETE remains classified as an intermediate\u2010risk feature for recurrence in thyroid cancer. The prognostic significance of mETE and its association with recurrence risk remain subjects of ongoing debate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analyzed a retrospective cohort of 1870 papillary thyroid carcinoma (PTC) patients who underwent total thyroidectomy (TT) with central lymph node dissection (CLND) between 2015 and 2020. Cox proportional hazards regression models and subgroup analyses were employed to evaluate the association of mETE with structural recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After a median follow\u2010up of 27.9\u2009months, 124 patients (6.6%) experienced structural recurrence. The recurrence rate was significantly higher in patients with mETE than in those without (11.0% vs. 5.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Subgroup analyses revealed that mETE was an independent risk factor, particularly in patients with bilateral tumors (HR: 2.99, 95% CI: 1.8\u20134.95) and those without Hashimoto's thyroiditis (HT) (HR: 2.33, 95% CI: 1.53\u20133.63). A significant interaction between tumor bilaterality and mETE was observed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with PTC, mETE is a significant prognostic factor of structural recurrence and is associated with decreased disease\u2010free survival (DFS). Critically, we demonstrate for the first time that mETE elevates recurrence risk to near the ATA intermediate\u2010high threshold (17.6%) in bilateral PTC, regardless of tumor size. This synergy of mETE and bilaterality supports upgrading risk stratification and intensifying surveillance for this subset.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70172","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T10:51:20Z","timestamp":1768819880000},"page":"1595-1604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimal Extrathyroidal Extension in Bilateral Papillary Thyroid Carcinoma Is Associated With Postoperative Structural Recurrence"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-7164","authenticated-orcid":false,"given":"Shaoyang","family":"Kang","sequence":"first","affiliation":[{"name":"School of Medicine, Nankai University  Tianjin China"},{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5919-5789","authenticated-orcid":false,"given":"Huajuan","family":"Bai","sequence":"additional","affiliation":[{"name":"Institute of Hospital Management Research, Medical Innovation &amp; Rese Arch Division, Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongzhou","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8210-8626","authenticated-orcid":false,"given":"Xiaodong","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The Sixth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaijin","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University  Tianjin China"},{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8205-0762","authenticated-orcid":false,"given":"Anning","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-4831","authenticated-orcid":false,"given":"Zhaohui","family":"Lyu","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University  Tianjin China"},{"name":"Department of Endocrinology The First Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.02.023"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820904923"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2018.09.015"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12022\u2010022\u201009707\u20103"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00407"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2020.04.003"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020\u2010023\u201003533\u20101"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21439"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21388"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/10507256251363120"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.28113"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.121.261898"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018\u201000081"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010013\u20103447\u2010y"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2021.0248"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djad105"},{"issue":"3","key":"e_1_2_9_18_1","first-page":"181","article-title":"Guidelines for the Diagnosis and Management of Thyroid Nodules and Differentiated Thyroid Cancer (Second Edition)","volume":"39","author":"Chinese Society of Endocrinology","year":"2023","journal-title":"Chinese Journal of Endocrinology and Metabolism"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01687"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.893683"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2019.0753"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12020350"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618\u2010018\u20100854\u20108"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.21037\/gs\u201024\u2010147"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2010.02.008"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.466"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12022\u2010012\u20109202\u20102"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.18526"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(20)30115\u20107"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010019\u201050069\u20104"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13277\u2010015\u20104533\u20105"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE\u201021\u20100091"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24010371"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2014.03.003"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70172","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70172","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70172","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:25:11Z","timestamp":1780997111000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":34,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/hed.70172"],"URL":"https:\/\/doi.org\/10.1002\/hed.70172","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]},"assertion":[{"value":"2025-08-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}