Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta‐analysis

Cui, Likun; Feng, Dongdong; Zhu, Chaofan; Li, Qiuyu; Li, Wenqing; Liu, Baoguo

doi:10.1002/lio2.824

Cited by 11 publications

(4 citation statements)

References 61 publications

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“…However, they did not focus on low-risk patients only and the subsequent de-escalation movement. A recent review and meta-analysis by Cui et al ( 21 ) reported on the clinical outcomes of multifocal PTC and showed that multifocal disease is more aggressive in contrast to unifocal disease and that it is accompanied by an increased risk of recurrence. They did not mention bilaterality.…”

Section: Discussionmentioning

confidence: 99%

Bilaterality, not multifocality, is an independent risk factor for recurrence in low-risk papillary thyroid cancer

Schaap

Lin

Metman

et al. 2023

JNCI: Journal of the National Cancer Institute

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Introduction The impact of multifocality and bilaterality on recurrence in patients with low-risk, papillary thyroid cancer, is relevant when considering patients for a de-escalated treatment strategy: Hemithyroidectomy (HT) instead of total thyroidectomy followed by radioactive iodine (TT+/- RAI). This study aims to analyse contralateral tumor probability in patients treated for low-risk papillary thyroid cancer and assess multifocality and bilaterality as possible predictors for recurrence. Methods Patients with low-risk papillary thyroid cancer treated with TT+/-RAI in the Netherlands between 2005 and 2015 were included in this study. Patients were identified from the Netherlands Comprehensive Cancer Organization (IKNL), and linked with the nationwide network and registry of Pathology in the Netherlands (PALGA). Contralateral tumor probability and recurrence were assessed. Results Of 791 included patients, 41.8% (331/791) had multifocal disease, with 68.9% (228/331) of those cases being bilateral disease. The contralateral tumor probability after HT was 24.6% (150/610). for patients with unifocal disease and 43.1% (78/181) for patients with multifocal disease. We found a higher trend of recurrence in patients with bilateral disease, regardless of multifocality: In patients with contralateral disease after pre-completion diagnosed unifocal disease 7.3% (11/150) had recurrent disease, while patients without contralateral disease after pre-completion diagnosed multifocal disease, 1.9% (2/103) had recurrence. Cox regression analysis showed that bilaterality (HR = 3.621;.95%CI=1.548-8.471) was the sole significant risk factor for recurrence. Conclusion Low recurrence rates are found in patients with either multifocal or bilateral disease in patients with low-risk papillary thyroid cancer. Bilaterality should be taken into account when considering these patients for de-escalated treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Bilaterality, not multifocality, is an independent risk factor for recurrence in low-risk papillary thyroid cancer

Schaap

Lin

Metman

et al. 2023

JNCI: Journal of the National Cancer Institute

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“…3 Many meta-analytic studies have found that multifocal PTC is associated with progression and recurrence. [4][5][6][7] Feng et al reported on multifocal PTC (n = 157, 24.7%) in their retrospective study of data from 635 PTC patients; also showing multifocality to be associated with an increased risk of recurrence, lymph node metastases, vascular invasion, and extra-thyroidal extension, that, moreover, increased the more tumor foci were present. 8 On the other hand, Harach et al reported the common occurrence of occult PTC (52 foci in 36 thyroids) in their autopsy study (n = 101), 10 of which showed multifocality with 2-5 foci.…”

Section: Introductionmentioning

confidence: 99%

“…This may be reflected in the clinical and prognostic importance of multifocality still being controversial 3 . Many meta‐analytic studies have found that multifocal PTC is associated with progression and recurrence 4–7 . Feng et al reported on multifocal PTC ( n = 157, 24.7%) in their retrospective study of data from 635 PTC patients; also showing multifocality to be associated with an increased risk of recurrence, lymph node metastases, vascular invasion, and extra‐thyroidal extension, that, moreover, increased the more tumor foci were present 8 .…”

Section: Introductionmentioning

confidence: 99%

Multi‐UniFocality (MUF), in contrast to multifocality, in thyroid lesions: Relation to lymphocytic thyroiditis

Aydemirli,

Morreau

2024

Pathology International

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Whereas multifocality typically concerns papillary thyroid carcinoma (PTC) without specification of intrathyroidal metastatic or independent nature of tumor foci, the designation of the latter as Multi‐UniFocal (MUF) may be relevant for select cases. A case series involving multifocal thyroid lesions with divergent histopathological morphology and/or molecular profile, with molecular evaluation of multiple individual tumor foci per patient based on a next‐generation sequencing approach, was retrospectively reviewed. Twenty‐five patient cases with multifocal thyroid lesions suggestive of MUF, with 2–6 (median 3) tumor foci per patient, were described. Tumor lesions comprised diverse histopathology, including PTC, (E)FVPTC, NIFTP, FA, FTC, and oncocytic. Morphologically similar and/or diverse tumor foci harbored different molecular alterations (suggestive of non‐shared clonality); with(out) coexistent similar foci harboring identical molecular alterations; or (partly) shared molecular alterations. MUF was associated with chronic lymphocytic thyroiditis in almost half of the cases. The recognition of MUF may justify the independent clinical consideration per individual tumor focus; as separate lesions albeit within a multifocal context. The potential clinical relevance and prognostic value of MUF remain to be further established.

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“…There have been major changes in the management of lowrisk differentiated thyroid cancer (DTC) over the period of 2000 to 2018, consistent with the American Thyroid Association (ATA) guidelines, which suggest less extensive surgical management of low-risk tumors (1,2). The proportion of thyroid lobectomy rather than total thyroidectomy slightly increased during the 2014-2018 period (1).…”

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confidence: 99%

Unilateral Multifocality Is Not a Risk Factor for Recurrence After Thyroid Lobectomy: A Study of 1,684 Patients With Differentiated Thyroid Cancer

Cho

Kim

2023

In Vivo

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Background/Aim: Many studies indicate that multifocality is associated with high-risk features of differentiated thyroid cancer (DTC). Herein, we evaluated the impact of the unilateral multifocality on post-lobectomy recurrence in patients with DTC. Patients and Methods: We retrospectively analyzed 1,684 patients with DTC who underwent thyroid lobectomy from 2008 to 2015 using logistic regression models to calculate the relative risk on postlobectomy recurrence. Results: Tumor diameter increased from 4.9 mm to 8.1 mm and the proportion of extrathyroidal extension (ETE) and unilateral multifocality progressively increased from 2008 to 2015 (2.1% to 24.3% and 4.2% to 22.8%, respectively). During the 88.6-month follow-up period, 67 (3.98%) recurrences and 2 (0.12%) deaths were observed. There were 269 (16.0%) multifocal DTC cases. There was no significant difference between the multifocal and unifocal groups in terms of the proportion of recurrences (5.2% vs. 3.7%) and distant metastasis (0.4% vs. 0.1%). Logistic regression analysis revealed age <42.5 years (OR=1.83), tumor diameter greater than 7.5 mm (OR=1.89), and N1a (OR=2.04) were potent risk factors for post-lobectomy recurrence. Conversely, male sex (OR=0.77; p=0.407), ETE (OR=1.16; p=0.698) and multifocality (OR=1.23; p=0.526) were not risk factors for recurrence after thyroid lobectomy. A positive node ratio (PNR) ≥42.0%, N1a stage, a tumor diameter ≥7.5mm and age <42.5 years were significant risk factors for recurrence p=0.001, p=0.004 and p=0.009, respectively). Contrariwise, multifocality and ETE were proven to not be risk factors for DTC recurrence after thyroid lobectomy respectively). Conclusion: Unilateral multifocality was not a risk factor for DTC recurrence after thyroid lobectomy and could not be considered an indication for immediate completion or total thyroidectomy.

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Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta‐analysis

Cited by 11 publications

References 61 publications

Bilaterality, not multifocality, is an independent risk factor for recurrence in low-risk papillary thyroid cancer

Bilaterality, not multifocality, is an independent risk factor for recurrence in low-risk papillary thyroid cancer

Multi‐UniFocality (MUF), in contrast to multifocality, in thyroid lesions: Relation to lymphocytic thyroiditis

Unilateral Multifocality Is Not a Risk Factor for Recurrence After Thyroid Lobectomy: A Study of 1,684 Patients With Differentiated Thyroid Cancer

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