Is lobectomy sufficient for multifocal papillary thyroid microcarcinoma?

Area of Science:

• Endocrinology
• Oncology
• Surgical Pathology

Background:

• Multifocal papillary thyroid microcarcinoma (PTMC) is associated with increased lymph node involvement, bilateral disease, and extrathyroidal extension compared to unifocal papillary thyroid cancer (PTC).
• Understanding survival determinants in PTMC is crucial for patient management and treatment strategies.

Purpose of the Study:

• To determine the incidence and prognostic factors of survival for patients diagnosed with multifocal PTMC.
• To analyze survival trends using a large population-based dataset.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Result (SEER) registry to identify 22,283 cases of PTMC (T1a N0 M0) diagnosed between 2010 and 2015.
• Analyzed patient data for overall survival (OS) and disease-specific survival (DSS), considering age, sex, race, tumor multifocality, and surgical approach (total thyroidectomy vs. lobectomy).

Main Results:

• Multifocal PTMC was identified in 32.2% of cases. Overall survival at 2 and 5 years was high (98% and 95%, respectively).
• Multivariate analysis indicated that age, sex, and multifocality were significant determinants of OS, while only age influenced DSS.
• Kaplan-Meier analysis showed no significant difference in mean OS between patients who underwent lobectomy versus total thyroidectomy for multifocal PTMC.

Conclusions:

• Papillary thyroid microcarcinoma demonstrates a favorable prognosis.
• Age, sex, and multifocality are key prognostic factors for OS in PTMC patients.
• Surgical approach (lobectomy or total thyroidectomy) does not appear to impact survival outcomes in multifocal PTMC.