Outcomes and Pathological Features of Total Thyroidectomy in Patients with Multifocal Papillary Thyroid Carcinoma

Year 2023, Volume: 25 Issue: 1, 50 - 55, 30.04.2023

Seyed Ziaeddin Rasihashemi Zahra Shilan Samad Farashi Bonab Ebrahim Farashi

https://doi.org/10.18678/dtfd.1202143

Abstract

Aim: The incidence of thyroid cancer has increased dramatically in recent decades. Multifocality is considered a poor prognostic factor for papillary thyroid carcinoma (PTC). Patients with multifocal PTC (MPTC) are at high risk for local recurrence, as well as lymphatic and distal metastases. This study examined the features and outcomes of MPTC.
Material and Methods: This retrospective study was conducted on 300 patients with PTC. Patients were classified into a multifocal group and a unifocal group. The pathological features of the PTC and the patients’ outcomes were analyzed and compared.
Results: The multifocal group included 146 patients (48.7%), while the unifocal group included 154 patients (51.3%). The occurrence of multifocality was higher in females than in males (Odds ratio, OR: 2.37, 95% confidence interval, CI: 1.20-4.67, p=0.015). Tumor size of >1 cm in the multifocal group was larger than in the unifocal group (2.5 and 2.2 cm, respectively, p=0.021). Moreover, in multifocal group higher moderate risk of recurrence was detected than in the unifocal group (OR: 1.63, 95% CI: 1.01-2.60, p=0.044). At follow-up after treatment, MPTC patients had higher lymph node metastasis (OR: 2.89, 95% CI: 1.23-6.80, p=0.014). In addition, significantly higher thyroglobulin plasma levels (p=0.026) and disease recurrence (OR: 2.41, 95% CI: 1.05-5.52, p=0.037) were found in the multifocal group compared to the unifocal group.
Conclusion: Patients with MPTC had a higher risk of disease recurrence, and multifocality was concluded to be an independent prognostic factor for overall disease recurrence.

Keywords

papillary thyroid carcinoma, thyroidectomy, multifocality, recurrence

Multifokal Papiller Tiroid Karsinomlu Hastalarda Total Tiroidektominin Sonuçları ve Patolojik Özellikleri

Abstract

Amaç: Tiroid kanseri insidansı son yıllarda önemli ölçüde artmıştır. Multifokalite, papiller tiroid karsinomu (papillary thyroid carcinoma, PTC) için kötü bir prognostik faktör olarak kabul edilir. Multifokal PTC (MPTC)li hastalar, lenfatik ve distal metastazların yanı sıra lokal nüks açısından yüksek risk altındadır. Bu çalışmada MPTC özellikleri ve sonuçları incelendi.
Gereç ve Yöntemler: Bu retrospektif çalışma, 300 PTC’li hasta üzerinde yapıldı. Hastalar multifokal grup ve unifokal grup olmak üzere sınıflandırıldı. PTC'nin patolojik özellikleri ve hastaların sonuçları analiz edildi ve karşılaştırıldı.
Bulgular: Multifokal grupta 146 hasta (%48,7), unifokal grupta ise 154 hasta (%51,3) vardı. Multifokalite oluşumu kadınlarda erkeklerden daha yüksekti (Odds ratio, OR: 2,37, %95 güven aralığı, GA: 1,20-4,67; p=0,015). Multifokal gruptaki >1 cm olan tümör boyutu, unifokal gruptakinden daha büyüktü (sırasıyla 2,5 ve 2,2 cm; p=0,021). Ayrıca, multifokal gruptaki orta düzeyde nüks riskinin unifokal gruba göre daha yüksek olduğu saptandı (OR: 1,63, %95 GA: 1.01-2.60; p=0,044). Tedavi sonrası takipte, MPTC hastalarında daha yüksek lenf nodu metastazı vardı (OR: 2,89, %95 CI: 1,23-6,80; p=0,014). Ek olarak, tiroglobulin plazma seviyeleri (p=0.026) ve hastalık nüksü (OR: 2,41, %95 CI: 1,05-5,52; p=0,037), multifokal grupta unifokal gruba göre anlamlı olarak daha yüksek bulundu.
Sonuç: MPTC'li hastalarda hastalık nüksü riski daha yüksekti ve multifokalitenin genel hastalık nüksü için bağımsız bir prognostik faktör olduğu sonucuna ulaşıldı.

Keywords

papiller tiroid karsinomu,, tiroidektomi, multifokalite,, nüks

References

• Lang BH, Yih PC, Shek TW, Wan KY, Wong KP, Lo CY. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. J Surg Oncol. 2012;106(8):966-71.
• Bishop J. Cancer facts. London: CRC Press; 1999.
• Xing M. Molecular pathogenesis and mechanisms of thyroid cancer. Nat Rev Cancer. 2013;13(3):184-99.
• Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306.
• Lin JD, Chen ST, Chao TC, Hsueh C, Weng HF. Diagnosis and therapeutic strategy for papillary thyroid microcarcinoma. Arch Surg. 2005;140(10):940-5.
• Kuo SF, Lin SF, Chao TC, Hsueh C, Lin KJ, Lin JD. Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol. 2013;2013:809382.
• Wang W, Su X, He K, Wang Y, Wang H, Wang H, et al. Comparison of the clinicopathologic features and prognosis of bilateral versus unilateral multifocal papillary thyroid cancer: an updated study with more than 2000 consecutive patients. Cancer. 2016;122(2):198-206.
• La Greca A, Xu B, Ghossein R, Tuttle RM, Sabra MM. Patients with multifocal macroscopic papillary thyroid carcinoma have a low risk of recurrence at early follow-up after total thyroidectomy and radioactive iodine treatment. Eur Thyroid J. 2017;6(1):31-9.
• Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 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. 2016;26(1):1-133.
• Ng SC, Kuo SF, Chen ST, Hsueh C, Huang BY, Lin JD. Therapeutic outcomes of patients with multifocal papillary thyroid microcarcinomas and larger tumors. Int J Endocrinol. 2017;2017:4208178.
• Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.
• Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, et al. editors. Cummings otolaryngology - head & neck surgery. Philadelphia, PA: Mosby/Elsevier; 2010. p.1750-72.
• Ali SZ, Cibas ES. The Bethesda system for reporting thyroid cytopathology: definitions, criteria, and explanatory notes. New York: Springer; 2010.
• Choi WR, Roh JL, Gong G, Cho KJ, Choi SH, Nam SY, et al. Multifocality of papillary thyroid carcinoma as a risk factor for disease recurrence. Oral Oncol. 2019;94:106-10.
• Geron Y, Benbassat C, Shteinshneider M, Or K, Markus E, Hirsch D, et al. Multifocality is not an independent prognostic factor in papillary thyroid cancer: a propensity score-matching analysis. Thyroid. 2019;29(4):513-22.
• Ashcraft MW, Van Herle AJ. The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up study of patients with treated differentiated thyroid cancer. Am J Med. 1981;71(5):806-14.
• Ozata M, Suzuki S, Miyamoto T, Liu R, Fierro-Renoy F, DeGroot LJ. Serum thyroglobulin in the follow-up of patients with treated differentiated thyroid cancer. J Clin Endocrinol Metab. 1994;79(1):98-105.
• Gur EO, Karaisli S, Haciyanli S, Kamer E, Genc H, Atahan K, et al. Multifocality related factors in papillary thyroid carcinoma. Asian J Surg. 2019;42(1):297-302.