Optimal Surgical Extent in Patients with Unilateral Multifocal Papillary Thyroid Carcinoma

Woo, Joo Hyun; Kwon, Hyungju

doi:10.3390/cancers14020432

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Current knowledge suggests that cervical lymph node metastasis is the most crucial variable to increase the risk of local recurrence and overall survival ( 6 ). Our recent study ( 7 ) and studies by others ( 8 , 9 ) have suggested that MPTC increases the risk of cervical lymph node metastasis. Cervical lymph node metastasis is often accompanied with a poor prognosis, including distant metastasis and persistent or recurrent disease.…”

Section: Introductionmentioning

confidence: 65%

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Zhang

Wang

et al. 2022

Front. Oncol.

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IntroductionIdentifying risk variables for cervical lymph node metastases in multifocality papillary thyroid cancer (MPTC) could assist surgeons in determining whether cervical lymph node dissection would be an appropriate surgical option.MethodsA retrospective cohort of 2006 patients with papillary thyroid cancer were selected. MPTC (N = 460) was defined as the presence of two or more foci of PTC. The risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in MPTC were investigated by univariate and multivariate analyses, including the following items: age at diagnosis, gender, Hashimoto’s thyroiditis, extrathyroidal extension (ETE), maximal axial diameter (MAD) and the sum of axial diameters (SAD) of tumor. In addition, CLNM was used to evaluate LLNM.ResultsThe incidence of CLNM and LLNM was 44.57% and 17.17%, respectively. The multivariate analysis demonstrated that gender, extrathyroidal extension (ETE), age, maximal axial diameter (MAD), and the sum of axial diameters (SAD) were related to increased risk for CLNM in MPTC (p < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for age at diagnosis of CLNM was 0.647, the cut-off value was 50 years old. Additionally, by multivariate analysis, CLNM, ETE, MAD, and SAD were independent risk factors for LLNM in MPTC (p < 0.05). ROC curve analysis demonstrates that AUC for MAD and SAD diagnosis of LLNM were 0.639 and 0.757, and the cut-off values were 16 and 26 mm, respectively.ConclusionsMPTC patients who have risk factors for CLNM were advised to perform prophylactic central lymph node dissection (CLND). Additionally, the presence of risk factors for LLNM should be individually evaluated and analyzed for the necessity of lateral lymph node dissection.

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Section: Introductionmentioning

confidence: 65%

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Zhang

Wang

et al. 2022

Front. Oncol.

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“…Крім того, установлено, що двобічні та однобічні МФ карциноми мали однакову частоту локорегіонарних і віддалених рецидивів, білатеральність при багатовогнищевому ПРЩЗ не пов'язана з гіршим прогнозом, а більшість випадкових контралатеральних пухлин є мікрокарциномами і не змінюють категорії ризику рецидиву та виживання [98]. Наявність однобічної МФ у пацієнтів після ЛЕ не мала суттєвого впливу на регіонарний рецидив [33,40,128] чи вірогідність контралатерального ПРЩЗ та виживаність хворих [45]. Відсутність самостійного прогностичного впливу МФ на клінічні результати продемонстували результати кількох досліджень [42,53,110].…”

Section: Lectures • лекціїunclassified

Multifocal papillary thyroid cancer in children and adults. Lecture

Tovkai¹,

Palamarchuk²,

Hryshchenko³

et al. 2022

CE&ES

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Thyroid cancer is the 9th most common cancer in the world. Thus, in the year 2020, 586.000 cases of thyroid cancer were registered worldwide. The incidence rate among women is 10.1 per 100 thousand population, and among men — 3.1 per 100 thousand population. In Ukraine, in 2019, the standardized rate of incidence of thyroid cancer (world standard) was 6.9 per 100.000 population (2.8 among men, 10.5 among women). In the structure of the incidence of malignant neoplasms of the cervical spine, thyroid cancer ranks first place among women aged 18 — 29 (19.9 %), fourth among both men aged 18 — 29 (8.3 %, and women aged 30 — 54 (8.1 %). Over the past 40 years, increased incidence of thyroid cancer (in particular, papillary thyroid cancer) is observed in most countries, which can be explained by various factors, for example, overdiagnosis, a change in the prevalence of modified risk factors. In Ukraine, in the period from 1989 to 2012, the rate of incidence of papillary thyroid cancer among men increased by 115 %, among women — by 137 %, the annual increase in incidence of papillary thyroid cancer for men and women was 5 and 6 %, respectively. Multifocality in papillary thyroid cancer is a characteristic feature that is much more common in pediatric patients than in adults, but the number of studies in children is limited, which is associated with a lower prevalence of the disease in children. The results of investigations on the multifocality predictors and its role in influencing relapse, persistence, and survival in patients with papillary thyroid cancer are conflicting in both adults and pediatric population. Among the risk factors of multifocality, a smaller number of controversies concerns the links of metastasis in the lymphatic nodes, radiation in the anamnesis, childhood age, and for bilaterality — multifocality of the primary lobe and the presence of contralateral benign nodes (in adults). Other factors as predictors of multifocality have controversial significance and deserve attention in further research. The identification of reliable predictors of multifocality, especially with the help of preoperative data analysis, as well as multifocality risk stratification will facilitate the complex decision‑making process for the correct treatment tactics of children and adults with papillary thyroid cancer.

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“…They proposed that multifocal PTMC should be treated using strategies different from those of multifocal macro-PTC (11). Harries et al (12) and Woo et al (13) further suggested that multifocal PTC should not be considered an indication for completion thyroidectomy. Geron et al revealed that multifocality is not an independent prognostic factor, as proven by propensity score-matching analysis (14).…”

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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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Optimal Surgical Extent in Patients with Unilateral Multifocal Papillary Thyroid Carcinoma

Cited by 4 publications

References 29 publications

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Multifocal papillary thyroid cancer in children and adults. Lecture

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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