{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T16:39:42Z","timestamp":1773074382449,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T00:00:00Z","timestamp":1566777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>In papillary thyroid cancer (PTC), the adverse prognostic impact of extrathyroidal extension (macro\u2010ETE) invading the subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve (T4a disease) is well established. We investigated whether the extent of macro\u2010ETE, defined as \u201climited\u201d with single structure involvement (lim\u2010ETE) and \u201cextensive\u201d with multiple structures involved (ext\u2010ETE), influences prognosis in T4a PTC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of 610 patients with PTC identified 39 with T4a disease, including 26 with lim\u2010ETE and 13 with ext\u2010ETE. Univariate Cox regression was used to assess the relationship between the extent of macro\u2010ETE and recurrence\u2010free survival (RFS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ext\u2010ETE was associated with a five times increased risk of recurrence compared to lim\u2010ETE (HR 5.0, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.030), with or without adjustment for radioactive iodine administration and after adjustment for margin status (HR 4.7; <jats:italic>P<\/jats:italic>\u2009=\u2009.041). A low\u2010risk subset of T4a disease comprising of patients aged less than 55 years with lim\u2010ETE and clear margins accounted for one\u2010third of the cohort and demonstrated an excellent 5\u2010year RFS of 92%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The extent of macro\u2010ETE appears to be an important determinant of prognosis in T4a PTC. A low\u2010risk subset of T4a disease exists with an excellent prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25683","type":"journal-article","created":{"date-parts":[[2019,8,27]],"date-time":"2019-08-27T04:53:23Z","timestamp":1566881603000},"page":"1016-1022","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The extent of extrathyroidal extension is a key determinant of prognosis in T4a papillary thyroid cancer"],"prefix":"10.1002","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9554-5211","authenticated-orcid":false,"given":"Earl","family":"Abraham","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Roshan","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"},{"name":"Department of Medicine University of New South Wales  NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Wykes","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"},{"name":"Department of Medicine University of New South Wales  NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ardalan","family":"Ebrahimi","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Liverpool Hospital  NSW Australia"},{"name":"Department of 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