Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer

Abstract

The multifocal papillary thyroid cancer (PTC), with more aggressive and poorer prognosis, is not rare in papillary histotype. Few studies evaluated risk factors and lymph node metastasis in multifocal PTC. The aim of this present study focusing on risk factors and lymph node metastasis characteristics in multifocal PTC was excepted to assist clinical decisions regarding surgery.It was a retrospective study. The 1249 consecutive patients with PTC were reviewed. Of these, 570 patients who met the criteria were selected: 285 with solitary papillary thyroid cancer and 285 with multifocal PTC. The risk factors and lymph node metastasis in multifocal PTC were investigated by univariate and multivariate analysis.Multifocal PTC showed a higher positive rate of capsular invasion, extrathyroidal extension, tumor size >10 mm, pathological T classification, N+ stage, local recurrence, and radioactive iodine ablation (RAI). Capsular invasion (hazard ratio [HR], 1.589; 95% confidence interval [CI],1.352–1.984), advanced pathological T classification (HR, 3.582; 95% CI, 2.184–5.870), and pathological N+ stage (HR, 1.872; 95% CI, 1.278–2.742) were related to increased risk of multifocality and there was a significant increased HR for central neck compartment involvement in male sex (HR, 2.694; 95% CI, 1.740–4.169), advanced pathological T classification (HR, 2.403; 95% CI, 1.479–3.907) and multifocality (HR, 1.988; 95% CI, 1.361–2.906).There is a significant association between capsular invasion, advanced pathological T classification, N+ stage, and multifocal PTC. Total thyroidectomy plus prophylactic bilateral central lymph node dissection should be recommended during surgery due to a stronger predilection for level VI lymph node metastasis in multifocal PTC.

Prognostic significance of the sum of the diameters of single foci in multifocal papillary thyroid cancer: the concept of new-old tumor burden

“…On the other hand, more advanced T-categories (on TNM staging) were more frequently associated with multifocality, as reported by other groups. 10 , 16 , 18 …”

“… 11 , 15 , 17 It is only in some studies that Mu seemed to be associated with vascular invasion, lymph node metastases, more advanced disease and higher Initial Risk Stratification System (IRSS) scores. 16 , 18 Nevertheless, the real prognostic significance of Mu in contributing to PTC persistence/recurrence, or even mortality, remains controversial. As an example, two recent meta-analyses reported opposite findings.…”

Main Prognostic Factors for Well Differentiated Thyroid Cancer: Analis of Combined Patients Treatment Results during 20 Years after Surgery

“…One of these characters is multifocal tumor growth character; in this case the patient survival being worse comparing to ones whose carcinomas are without this character ( Table 2). The multi-focal tumor growth character is associated with capsular invasion, metastases to lymph nodes, and tumors belonging to the category Т2-Т4 [20].…”

Papillary thyroid cancer and thyroid stimulating hormone: does sex matter?

“…The incidence of PTC is about 3 times higher in females than in males [3][4][5]. Specific clinical and pathological differences between male and female PTC patients have been reported [5][6][7][8]. There are some data demonstrating that female patients with PTC had an earlier age of onset, whereas males tend to have a more aggressive disease with higher mortality [5,8].…”

“…Specific clinical and pathological differences between male and female PTC patients have been reported [5][6][7][8]. There are some data demonstrating that female patients with PTC had an earlier age of onset, whereas males tend to have a more aggressive disease with higher mortality [5,8]. However, the reasons for these sex differences are unclear.…”