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A quantitative assessment of the number of disease foci in papillary thyroid cancer

Published:November 29, 2022DOI:https://doi.org/10.1016/j.ejso.2022.11.592

      Abstract

      Aim

      Multifocality is a frequent feature of papillary thyroid carcinoma (PTC). Its prognostic value is controversial although national guidelines recommend treatment intensification if present. However, multifocality is not a binary but discrete variable. This study aimed to examine the association between increasing number of foci and risk of recurrence following treatment.

      Methods

      577 patients with PTC were identified with median follow-up of 61 months. Number of foci were taken from pathology reports. Log-rank test was used to assess significance. Multivariate analysis was performed and Hazard Ratios were calculated.

      Results

      Of 577 patients, 206(35%) had multifocal disease and 36(6%) recurred. 133(23%), 89(15%) and 61(11%) had 3+, 4+ or 5+ foci respectively. The 5-year RFS stratified by number of foci was 95%v93% for 2+foci (p = 0.616), 95%v96% for 3+foci (p = 0.198) and 89%v96% for 4+foci (p = 0.022). The presence of 4 foci was associated with an over 2-fold risk of recurrence (HR 2.296, 95% CI 1.106–4.765, p = 0.026) although this was not independent of TNM staging. Of the 206 multifocal patients, 31(5%) had 4+foci as their sole risk factor for treatment intensification.

      Conclusion

      Although multifocality per se does not confer worse outcome in PTC, finding 4+foci is associated with worse outcome and could therefore be appropriate as a cut-off for treatment intensification. In our cohort, 5% of patients had 4+foci as a sole indication for treatment intensification, suggesting that such a cut off could impact clinical management.

      Keywords

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      References

        • Iacobone M.
        • Jansson S.
        • Barczyński M.
        • Goretzki P.
        Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES).
        Langenbeck's Arch Surg. 2014 Feb 1; 399: 141-154
        • Li L.
        • Sawant R.
        • Hey S.
        • Harding N.
        • Ashley H.
        • Adamson R.
        • et al.
        Multifocality and its role in treatment intensification in papillary thyroid cancer.
        Eur J Surg Oncol. 2021 Feb 1; 47: e7
        • Mitchell A.L.
        • Gandhi A.
        • Scott-Coombes D.
        • Perros P.
        Management of thyroid cancer: United Kingdom national multidisciplinary guidelines.
        J Laryngol Otol. 2016 May; 130: S150-S160
        • Haugen B.R.
        • Alexander E.K.
        • Bible K.C.
        • Doherty G.M.
        • Mandel S.J.
        • Nikiforov Y.E.
        • et al.
        American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2015; 26 (2016 Jan 1): 1-133
        • Laustsen J.
        • Jensen L.P.
        • Hansen A.K.
        • Danish National Vascular Registry
        Accuracy of clinical data in a population based vascular registry.
        Eur J Vasc Endovasc Surg. 2004 Feb; 27: 216-219
        • Rolston J.D.
        • Han S.J.
        • Chang E.F.
        Systemic inaccuracies in the National Surgical Quality Improvement Program database: implications for accuracy and validity for neurosurgery outcomes research.
        J Clin Neurosci. 2017 Mar; 37: 44-47
        • Sharp N.E.
        • Knott E.M.
        • Iqbal C.W.
        • Thomas P.
        • St Peter S.D.
        Accuracy of American college of surgeons national surgical quality improvement program pediatric for laparoscopic appendectomy at a single institution.
        J Surg Res. 2013 Sep; 184: 318-321
        • Olson E.
        • Wintheiser G.
        • Wolfe K.M.
        • Droessler J.
        • Silberstein P.T.
        Epidemiology of thyroid cancer: a review of the national cancer database.
        Cureus. 2000-2013; 11: e4127
      1. ([Internet])Thyroid cancer incidence statistics. Cancer Research UK, 2015 ([cited 2022 Aug 31]. Available from:)
        • Zhang T.
        • He L.
        • Wang Z.
        • Dong W.
        • Sun W.
        • Zhang P.
        • et al.
        The differences between multifocal and unifocal papillary thyroid carcinoma in unilateral lobe: a meta-analysis.
        Front Oncol. 2021 Sep 16; 11657237
        • Bilimoria K.Y.
        • Bentrem D.J.
        • Ko C.Y.
        • Stewart A.K.
        • Winchester D.P.
        • Talamonti M.S.
        • et al.
        Extent of surgery affects survival for papillary thyroid cancer.
        Ann Surg. 2007 Sep; 246 (discussion 381-384): 375-381
        • Filetti S.
        • Durante C.
        • Hartl D.
        • Leboulleux S.
        • Locati L.D.
        • Newbold K.
        • et al.
        Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2019 Dec; 30: 1856-1883
        • Wang F.
        • Yu X.
        • Shen X.
        • Zhu G.
        • Huang Y.
        • Liu R.
        • et al.
        The prognostic value of tumor multifocality in clinical outcomes of papillary thyroid cancer.
        J Clin Endocrinol Metab. 2017 Sep 1; 102: 3241-3250
        • Leboulleux S.
        • Bournaud C.
        • Chougnet C.N.
        • Zerdoud S.
        • Al Ghuzlan A.
        • Catargi B.
        • et al.
        Thyroidectomy without radioiodine in patients with low-risk thyroid cancer.
        N Engl J Med. 2022 Mar 10; 386: 923-932
        • Woo J.
        • Kim H.
        • Kwon H.
        Impact of multifocality on the recurrence of papillary thyroid carcinoma.
        J Clin Med. 2021 Nov 2; 10: 5144
        • Qu N.
        • Zhang L.
        • hai Ji Q.
        • xue Zhu Y.
        • ying Wang Z.
        • Shen Q.
        • et al.
        Number of tumor foci predicts prognosis in papillary thyroid cancer.
        BMC Cancer. 2014 Dec 4; 14: 914
        • Feng J.W.
        • Qu Z.
        • Qin A.C.
        • Pan H.
        • Ye J.
        • Jiang Y.
        Significance of multifocality in papillary thyroid carcinoma.
        Eur J Surg Oncol. 2020 Oct 1; 46: 1820-1828
        • Amoako-Tuffour Y.
        • Graham M.E.
        • Bullock M.
        • Rigby M.H.
        • Trites J.
        • Taylor S.M.
        • et al.
        Papillary thyroid cancer recurrence 43 Years following Total Thyroidectomy and radioactive iodine ablation: a case report.
        Thyroid Res. 2017 Oct 10; 10: 8
        • Durante C.
        • Montesano T.
        • Torlontano M.
        • Attard M.
        • Monzani F.
        • Tumino S.
        • et al.
        Papillary thyroid cancer: time course of recurrences during postsurgery surveillance.
        J Clin Endocrinol Metab. 2013 Feb; 98: 636-642
        • Grogan R.H.
        • Kaplan S.P.
        • Cao H.
        • Weiss R.E.
        • Degroot L.J.
        • Simon C.A.
        • et al.
        A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up.
        Surgery. 2013 Dec; 154 (discussion 1446-1447): 1436-1446