Significance of multifocality in papillary thyroid carcinoma

Feng, Jia-Wei; Qu, Zhen; Qin, An; Pan, Hua; Ye, Jing

doi:10.1016/j.ejso.2020.06.015

Cited by 72 publications

(80 citation statements)

References 27 publications

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“…reported that ETE is more commonly found in bilateral PTC than unilateral PTC (20.2% vs . 11.4%, p = 0.016) ( 37 ). Therefore, it is conjectured that ETE would be a risk factor for contralateral concealed PTC, and our retrospective research also got the same results.…”

Section: Discussionmentioning

confidence: 97%

“…It was reported that patients with ETE have a lower 10-year survival rate (75.2%) and a lower 10-year disease-specific survival rate (84.2%) (36). Also, Feng et al reported that ETE is more commonly found in bilateral PTC than unilateral PTC (20.2% vs. 11.4%, p = 0.016) (37). Therefore, it is conjectured that ETE would be a risk factor for contralateral concealed PTC, and our retrospective research also got the same results.…”

Section: Discussionmentioning

confidence: 98%

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Risk Factors for Contralateral Occult Carcinoma in Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study and Meta-Analysis

Zhang

Zheng

et al. 2021

Front. Endocrinol.

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BackgroundBilateral lesions are common in papillary thyroid carcinoma (PTC). For patients with unilateral PTC, occult carcinoma that is not detected preoperatively, but pathologically after surgery, might remain in the contralateral lobe. In this situation, inadequate surgical extent could cause relapse and even lead to re-operation. Here, we explore the frequency and investigate the risk factors of contralateral occult PTC in unilateral PTC through a retrospective study conducted by our team and published articles online, respectively.MethodsWe collected the patients’ clinical data in our hospital, whose cancer was determined to be confined to the unilateral lobe by preoperative image examination (N = 204). These patients underwent initially total or near-total thyroidectomy and included their clinical data in the meta-analysis. We searched related literature in the PubMed, Embase, MEDLINE, Cochrane, and Web of Science databases until December 7, 2020, in order to perform a meta-analysis. The relevant articles were examined and the eligible studies were included to assess the association between clinicopathologic factors and contralateral occult PTC.ResultsThe meta-analysis included nine studies (involving 4347 patients). Of these, eight studies were from the databases, and one study was our retrospective data. The meta-analysis showed that the prevalence of contralateral occult PTC was 26.6% in all patients. A tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and central lymph node metastasis were significantly associated with contralateral occult PTC. In contrast, sex, age, ETE, capsular invasion, BRAF mutation, Hashimoto thyroiditis, and lateral lymph node metastasis were insignificantly associated with contralateral occult PTC.ConclusionThe meta-analysis identified a tumor size > 1 cm, ipsilateral multifocality, contralateral benign nodule, and CLNM as being significant risk factors for contralateral occult PTC. These findings may guide the extent of surgery in unilateral PTC patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Risk Factors for Contralateral Occult Carcinoma in Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study and Meta-Analysis

Zhang

Zheng

et al. 2021

Front. Endocrinol.

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“…Bilateral tumors are part of multifocality and are more detailed. Patients with bilateral tumors are more likely to have extrathyroidal invasion, CLNM ( 43 ), and a worse outcome ( 44 ) than patients with unilateral multifocality ( 45 ). The univariate analysis in this study showed that both multifocality and bilateral tumors were significantly correlated with CLNM.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Elastography: A Web-Based Nomogram Improves the Preoperative Prediction of Central Lymph Node Metastasis in cN0 PTC

et al. 2022

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BackgroundGiven the difficulty of accurately determining the central lymph node metastasis (CLNM) status of patients with clinically node-negative (cN0) papillary thyroid carcinoma (PTC) before surgery, this study aims to combine real-time elastography (RTE) and conventional ultrasound (US) features with clinical features. The information is combined to construct and verify the nomogram to foresee the risk of CLNM in patients with cN0 PTC and to develop a network-based nomogram.MethodsFrom January 2018 to February 2020, 1,157 consecutive cases of cN0 PTC after thyroidectomy and central compartment neck dissection were retrospectively analyzed. The patients were indiscriminately allocated (2:1) to a training cohort (771 patients) and validation cohort (386 patients). Multivariate logistic regression analysis of US characteristics and clinical information in the training cohort was performed to screen for CLNM risk predictors. RTE data were included to construct prediction model 1 but were excluded when constructing model 2. DeLong’s test was used to select a forecast model with better receiver operator characteristic curve performance to establish a web-based nomogram. The clinical applicability, discrimination, and calibration of the preferable prediction model were assessed.ResultsMultivariate regression analysis showed that age, sex, tumor size, bilateral tumors, the number of tumor contacting surfaces, chronic lymphocytic thyroiditis, and RTE were risk predictors of CLNM in cN0 PTC patients, which constituted prediction model 1. Model 2 included the first six risk predictors. Comparison of the areas under the curves of the two models showed that model 1 had better prediction performance (training set 0.798 vs. 0.733, validation set 0.792 vs. 0.715, p < 0.001) and good discrimination and calibration. RTE contributed significantly to the performance of the prediction model. Decision curve analysis showed that patients could obtain good net benefits with the application of model 1.ConclusionA noninvasive web-based nomogram combining US characteristics and clinical risk factors was developed in the research. RTE could improve the prediction accuracy of the model. The dynamic nomogram has good performance in predicting the probability of CLNM in cN0 PTC patients.

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“…We demonstrated that multifocality was associated with higher ETE, LN metastasis, and microscopic resection margin involvement. Feng et al showed that patients with multifocal PTCs had higher risk of large tumor size, ETE, vascular invasion, and LN metastasis [ 29 ]. Other researchers further indicated that multifocality was related with aggressive histologic subtype or higher ATA risk of recurrence [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

Woo

Kim

Kwon

2021

JCM

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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.

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Significance of multifocality in papillary thyroid carcinoma

Cited by 72 publications

References 27 publications

Risk Factors for Contralateral Occult Carcinoma in Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study and Meta-Analysis

Risk Factors for Contralateral Occult Carcinoma in Patients With Unilateral Papillary Thyroid Carcinoma: A Retrospective Study and Meta-Analysis

Real-Time Elastography: A Web-Based Nomogram Improves the Preoperative Prediction of Central Lymph Node Metastasis in cN0 PTC

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

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