Determinants of Structural Recurrence in Papillary Thyroid Carcinoma: A 10-Year Single-Center Cohort Study

Well-differentiated papillary thyroid carcinoma (PTC) is generally tied to an exceptionally good outlook; nonetheless, a handful of pathological traits—most notably macroscopic extrathyroidal extension and tumor size reaching or exceeding 2 cm—have been linked with structural reappearance of disease. The present study aimed to determine which clinical and histopathological features most strongly predict disease-free survival in patients undergoing total thyroidectomy for PTC. A retrospective review of records was conducted, drawing on 750 subjects who underwent total thyroidectomy, either alone or accompanied by neck dissection, at a tertiary academic cancer referral institution from 2014 to 2024. Data covering clinical presentation, pathology reports, and oncologic follow-up were evaluated over a maximal tracking period of 100 months. The statistical framework comprised Kaplan–Meier survival plots, log-rank comparisons, and Cox proportional hazards regression. A structural recurrence occurred in 4% of the cohort, and overall survival was 99%. When subjected to multivariate testing, the sole factors that persisted as independent correlates of recurrence were macroscopic extrathyroidal extension (HR 3.29; P = 0.008) and tumor diameter (HR 1.32; P = 0.013). Neither age, smoking history, perineural nor vascular invasion, nor central neck node involvement showed a statistically meaningful relationship with structural relapse. Macroscopic extrathyroidal extension, together with increasing tumor diameter, emerged as the dominant prognostic factors for structural recurrence in the PTC population. Collaborative multi-institutional studies are called for to authenticate these patterns across the broader Brazilian populace.