Association of tumor size and focality with recurrence/persistence in papillary thyroid cancer patients treated with total thyroidectomy along with radioactive-iodine ablation and TSH suppression

Abstract

Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI 1.19-10.2). Disease free survival patterns on Kaplan-Meier's plots were alike for micro- and macro-unifocal groups, and similarly stayed comparable among the two multifocal groups. Our analysis showed that tumor multifocality rather than size is the significant factor determining prognosis; hence, total thyroidectomy is indicated for an optimal assessment of true focality in micro-PTC.

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

“…Otherwise, some authors [36][37][38] have found tumour multifocality as an important prognostic factor for disease recurrence/persistence, although the cohort was different from our study since they included patients with intermediate and high risk. Similar to our results (although with different inclusion criteria), others found no association between multifocality and tumour recurrence [39,40].…”

Papillary Thyroid Cancer Prognosis: An Evolving Field

“…Multifocality—Some studies indicated that multifocality is present in about 30–37% of PTC patients [ 83 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 ]. However, whether it may represent an independent risk factor for disease recurrence and overall mortality is still a matter of debate, because different reports produced conflicting results [ 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 126 ]. In particular, in a large multicenter study performed on 2638 PTC patients, multifocality was not found to be an independent prognostic marker for either PTC recurrence or death [ 124 ].…”

Management of Clinically Solitary Papillary Thyroid Carcinoma Patients According to Risk-Scoring Model for Contralateral Occult Carcinoma

“…Considering the high incidence of postoperative complications, the routine use of TT is not recommended for all patients with unilateral PTC. However, multifocal PTCs were reported to be associated with poor outcome, and increased risk of recurrence ( 7 , 12 , 13 ). High resolution of ultrasonography (US), which could detect foci as small as 2–3 mm, is currently used in detecting PTC and determining the scope of surgery ( 14 ).…”