Abstract
The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality can predict the recurrence of PTC. A total of 1249 patients who underwent total thyroidectomy for PTC at the Ewha Medical Center between March 2012 and December 2019 were reviewed. In this study, multifocality was found in 487 patients (39.0%) and the mean follow-up period was 5.5 ± 2.7 years. Multifocality was associated with high-risk features for recurrence, including extrathyroidal extension, lymph node metastasis, and margin involvement. After adjustment of those clinicopathological features, 10-year disease-free survival was 93.3% in patients with multifocal tumors, whereas those with unifocal disease showed 97.6% (p = 0.011). Multivariate Cox regression analysis indicated that male sex (HR 2.185, 95% CI 1.047–4.559), tumor size (HR 1.806, 95% CI 1.337–2.441), N1b LN metastasis (HR 3.603, 95% CI 1.207–10.757), and multifocality (HR 1.986, 95% CI 1.015–3.888) were independent predictors of recurrence. In conclusion, multifocality increased the risk of recurrence in patients with PTC. Patients with multifocal PTCs may need judicious treatment and follow-up approaches.
Highlights
Thyroid cancer is one of the more common cancers worldwide, and its incidence has rapidly increased over the last few decades [1]
We investigated the effect of multifocality to the recurrence of Papillary thyroid carcinoma (PTC) in a large cohort, using propensity score matching for adjustment of confounders
Univariate Cox proportional-hazards model indicated that male sex (HR 2.974, 95% CI 1.433–6.170), tumor size (HR 2.340, 95% CI 1.833–2.987), microscopic ETE (HR 2.708, 95% CI 1.186–6.182), lymph node (LN) metastasis (HR for N1a 3.858, 95% CI 1.587–9.380; HR for N1b 12.704, 95% CI 5.066–31.857), 131I remnant ablation (HR 6.512, 95% CI 2.709–15.656), and multifocality (HR 2.294, 95% CI 1.183–4.451) were significantly associated with the recurrence (Table 3)
Summary
Thyroid cancer is one of the more common cancers worldwide, and its incidence has rapidly increased over the last few decades [1]. In 2018, 567,233 patients were newly diagnosed with thyroid cancer, accounting for 3.1% of total cancer cases. Papillary thyroid carcinoma (PTC) represents more than 80% of all thyroid malignancies, which usually have a favorable prognosis [2]. Up to 50% of patients experience cancer relapse, including loco-regional recurrences or distant metastases [2,3]. Many studies have attempted to differentiate these patients at high risk from the population with excellent outcomes [4,5]. Several clinicopathological factors, including tumor size, extrathyroidal extension (ETE), and multifocality of tumor have been investigated to predict recurrence
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