Multifocality as independent prognostic factor in papillary thyroid cancer - A multivariate analysis

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Papillary thyroid carcinoma (PTC) can present as multifocal disease, but its prognostic implications and associated factors are not fully understood.
• The incidence of multifocal PTC varies widely (18-87.5%), necessitating further investigation into its impact on patient outcomes.

Purpose of the Study:

• To determine the prognostic significance of multifocality in PTC regarding relapse and survival rates.
• To analyze the correlation between multifocality and clinicopathological factors such as patient age, gender, tumor size, histological variants, lymph node metastasis, and surgical extent.

Main Methods:

• A cohort of 153 PTC patients (excluding pT4 or distant metastases) underwent total thyroidectomy.
• Lymph node dissection was performed in 76.5% of patients, with modified radical neck dissection for positive nodes.
• Multifocality was assessed in whole thyroid specimens, and outcomes were correlated with clinicopathological variables.

Main Results:

• Multifocality was identified in 28% of specimens, more prevalent in patients over 45 years and tumors >4 cm.
• Multifocality did not significantly correlate with gender, histology variants, or lymph node metastasis.
• Patients with multifocal PTC exhibited significantly higher locoregional relapse rates and shorter disease-free intervals and survival, with multifocality identified as an independent prognostic factor for DFI and CSS.

Conclusions:

• Multifocality is a significant prognostic factor in PTC, associated with increased risk of recurrence and reduced survival.
• Total thyroidectomy is recommended for all PTC patients to mitigate relapse risk and enhance disease-free interval and cancer-specific survival.