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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Article info
Publication history
Accepted:
November 29,
2022
Received in revised form:
November 10,
2022
Received:
October 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Ltd.
