Abstract

Simple SummaryAround 30% of patients with papillary thyroid cancer (PTC) have multifocality. As tumor multifocality could increase the risk of recurrence in patients with PTC, more aggressive treatments, including total thyroidectomy and higher-dose radioiodine, are commonly used to treat patients with multifocal PTC. However, it is unclear whether aggressive treatment can decrease the risk of recurrence. Our study of 718 patients demonstrated that thyroid lobectomy showed comparable recurrence-free survival to that of total thyroidectomy. Moreover, our findings indicated that thyroid lobectomy could be safely performed on multifocal PTC patients with high-risk factors, such as large tumor size or lymph node metastasis. In conclusion, thyroid lobectomy was not associated with the risk of recurrence in patients with multifocal PTCs. Multifocality in PTC may not always require aggressive surgery.Multifocality increases the risk of recurrence in patients with papillary thyroid carcinoma (PTC); however, it is unclear whether multifocality justifies more extensive or aggressive surgical treatment. Here, we evaluated the effect of the operative extent on the recurrence-free survival (RFS) of patients with multifocal PTC. Between 2010 and 2019, 718 patients with unilateral multifocal PTC were enrolled; 115 patients (16.0%) underwent ipsilateral thyroid lobectomy, and 606 patients (84.0%) underwent total thyroidectomy. With a mean follow up of 5.2 years, RFS was comparable between the total thyroidectomy and lobectomy groups (p = 0.647) after adjusting for potential confounders. Multivariable Cox regression analysis also demonstrated that the operative extent was not an independent predictor of recurrence (HR 1.686, 95% CI: 0.321–8.852). Subgroup analyses further indicated that both total thyroidectomy and thyroid lobectomy resulted in comparable RFS for multifocal PTC patients with other high-risk factors, including tumor size > 1 cm (p = 0.711), lymph node metastasis (p = 0.536), and intermediate ATA risk of recurrence (p = 0.682). In conclusion, thyroid lobectomy was not associated with the risk of recurrence in patients with multifocal PTCs. Multifocality in PTC may not always require aggressive surgery.

Highlights

  • Thyroid cancer is the ninth most prevalent cancer worldwide, and its incidence has dramatically increased over the last four decades [1]

  • Patients were included in the present study if they were 20 years or older, had a pathologic diagnosis of unilateral multifocal papillary thyroid carcinoma (PTC), and underwent curative-intent surgical treatment, including thyroid lobectomy or total thyroidectomy

  • The present study demonstrated that the operative extent of patients with unilateral multifocal PTC was not associated with risk of recurrence

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Summary

Introduction

Thyroid cancer is the ninth most prevalent cancer worldwide, and its incidence has dramatically increased over the last four decades [1]. The optimal surgical extent can be determined by several clinicopathological factors, including personal history of radiation treatment to the head and neck, familial history of thyroid cancer, tumor size, extrathyroidal extension (ETE), regional or distant metastases, and multifocality [2]. Tumor multifocality is a common finding in PTC, with a prevalence of 18–87% of cases in the literature [6]. Multifocality has been associated with the high-risk features of PTC, including aggressive histology, ETE, lymph node (LN) involvement, and distant metastasis [7,8]. More aggressive treatments, including total thyroidectomy and higher-dose radioiodine, are commonly used to treat patients with multifocal PTC [9,11,12,13]

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