{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T03:11:13Z","timestamp":1772939473931,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Purposes: To establish the appropriate staging system and assess the role of curative thyroidectomy alone (Surgery) vs. involved-site radiation therapy after open biopsy (OB-ISRT) in stage IE mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: We examined the Tokyo Classification as a modified classification. This retrospective cohort study included 256 patients with thyroid MALT lymphoma; 137 underwent standard therapy (i.e., OB-ISRT) and were enrolled for the Tokyo classification. Sixty stage IE patients with the same diagnosis were examined to compare Surgery with OB-ISRT. Results: Overall survival (p = 0.0092) and relapse-free survival (0.00113) were significantly better in stage IE vs. stage IIE under the Tokyo classification. No OB-ISRT and Surgery patients died, but three OB-ISRT patients relapsed. The incidence of permanent complications was 28% in OB-ISRT (mainly dry mouth) and 0% in Surgery (p = 0.027). The number of painkiller prescription days was significantly greater in OB-ISRT (p &lt; 0.001). During follow-up, the rate of the new appearance\/change of the low-density area in the thyroid gland was significantly higher in OB-ISRT (p = 0.031). Conclusions: The Tokyo classification allows an appropriate discrimination between stages IE and IIE MALT lymphoma. Surgery can provide a good prognosis in stage IE cases; it also avoids complications, shortens painful periods during treatment, and simplifies ultrasound follow-up.<\/jats:p>","DOI":"10.3390\/cancers15051451","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T02:04:11Z","timestamp":1677463451000},"page":"1451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Role of Surgery in Patients with Stage IE Primary Thyroid MALT Lymphoma Staged by a Modified Classification System: The Tokyo Classification"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2462-6775","authenticated-orcid":false,"given":"Yoshiyuki","family":"Saito","sequence":"first","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natsuko","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2877-6647","authenticated-orcid":false,"given":"Nami","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoko","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Radiology, Juntendo University, Tokyo 113-8431, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5302-5872","authenticated-orcid":false,"given":"Hiroto","family":"Narimatsu","sequence":"additional","affiliation":[{"name":"Cancer Prevention and Control Division, Kanagawa Cancer Center, Yokohama 241-8515, Japan"},{"name":"Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki 238-8522, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Takami","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2069-3249","authenticated-orcid":false,"given":"Kaori","family":"Kameyama","sequence":"additional","affiliation":[{"name":"Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kana","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chie","family":"Masaki","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junko","family":"Akaishi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyomi Yamada","family":"Hames","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masako","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miho","family":"Fukushita","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ai","family":"Yoshihara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritsuko","family":"Okamura","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chisato","family":"Tomoda","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akifumi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Matsuzu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wataru","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuji","family":"Nagahama","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeduk Yoshimura","family":"Noh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiminori","family":"Sugino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1002\/1097-0142(197201)29:1<252::AID-CNCR2820290138>3.0.CO;2-#","article-title":"Occurrence and prognosis of extranodal lymphomas","volume":"29","author":"Freeman","year":"1972","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3131","DOI":"10.1210\/jc.2013-1428","article-title":"Primary thyroid lymphoma: A clinical review","volume":"98","author":"Stein","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/ajcp\/aqz145","article-title":"Hashimoto thyroiditis in primary thyroid non-Hodgkin lymphoma: A systematic review and meta-analysis","volume":"153","author":"Travaglino","year":"2020","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1210\/jc.2017-01478","article-title":"Long-term outcomes of 107 cases of primary thyroid mucosa-associated lymphoid tissue lymphoma at a single medical institution in Japan","volume":"103","author":"Watanabe","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","unstructured":"Zelenetz, A., Gordon, L., Arbramson, J., Advani, R., Bartlett, N., Elizabeth Budde, L., and National Comprehensive Cancer Network (2022). NCCN clinical practice guidelines in oncology. B-cell lymphomas. Version 5.2022. J. Natl. Compr. Cancer Netw."},{"key":"ref_6","first-page":"1860","article-title":"Report of the committee on Hodgkin\u2019s disease staging classification","volume":"31","author":"Carbone","year":"1971","journal-title":"Cancer Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1200\/JCO.1989.7.11.1630","article-title":"Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin\u2019s disease: Cotswolds meeting","volume":"7","author":"Lister","year":"1989","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1200\/JCO.2013.54.8800","article-title":"Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification","volume":"32","author":"Cheson","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1111\/j.1365-2141.2011.08606.x","article-title":"Clinicopathological features of 171 cases of primary thyroid lymphoma: A long-term study involving 24 553 patients with Hashimoto\u2019s disease","volume":"153","author":"Watanabe","year":"2011","journal-title":"Br. J. Haematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1089\/thy.2013.0523","article-title":"Rituximab-including combined modality treatment for primary thyroid lymphoma: An effective regimen for elderly patients","volume":"24","author":"Watanabe","year":"2014","journal-title":"Thyroid"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1089\/thy.2021.0613","article-title":"The Relationship Between Primary Thyroid Lymphoma and Various Types of Thyroid Autoimmunity: A Retrospective Cohort Study of 498 Cases, Including 9 Cases with Graves\u2019 Disease","volume":"32","author":"Suzuki","year":"2022","journal-title":"Thyroid"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1148\/radiology.177.2.2217772","article-title":"Cervical lymph node metastasis: Assessment of radiologic criteria","volume":"177","author":"Stel","year":"1990","journal-title":"Radiology"},{"key":"ref_13","unstructured":"National Cancer Institute (2022, February 10). Common Terminology Criteria for Adverse Events (CTCAE), Available online: https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/ctc.htm#ctc_50."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/CCO.0b013e3283330848","article-title":"Primary thyroid lymphoma: A review of recent developments in diagnosis and histology-driven treatment","volume":"22","author":"Sosa","year":"2010","journal-title":"Curr. Opin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/20009666.2018.1424487","article-title":"Primary thyroid MALToma\u2013a rare diagnosis of an unassuming thyroid nodule","volume":"8","author":"Shrestha","year":"2018","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.14219\/jada.archive.2007.0358","article-title":"Dry mouth and its effects on the oral health of elderly people","volume":"138","author":"Turner","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.tripleo.2005.12.001","article-title":"Impact of dry mouth and hyposalivation on oral health-related quality of life of elderly Japanese","volume":"103","author":"Ikebe","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_18","unstructured":"Hall, E.J., and Giaccia, A.J. (2011). Radiobiology for the Radiologist, Wolters Kluwer Health."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/j.suronc.2010.06.002","article-title":"Primary thyroid lymphoma (correction of lympoma): Diagnostic and therapeutic dilemmas","volume":"19","author":"Sakorafas","year":"2010","journal-title":"Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000369443","article-title":"Cytological findings for the diagnosis of primary thyroid mucosa-associated lymphoid tissue lymphoma by fine needle aspiration","volume":"59","author":"Kaba","year":"2015","journal-title":"Acta Cytol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_22","first-page":"407","article-title":"FDG-PET\/CT-guided rebiopsy may find clinically unsuspicious transformation of follicular lymphoma","volume":"12","author":"Kuitunen","year":"2022","journal-title":"Cancer Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/ases.12847","article-title":"Total endoscopic thyroidectomy after open neck biopsy of the follicular lymphoma of the thyroid gland","volume":"14","author":"Nakao","year":"2021","journal-title":"Asian J. Endosc. Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/5\/1451\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:41:38Z","timestamp":1760121698000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/5\/1451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,24]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["cancers15051451"],"URL":"https:\/\/doi.org\/10.3390\/cancers15051451","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,24]]}}}