Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis

Yan, Ting; Qiu, Weimin; Song, Jianlu; Ying, Tao; Fan, Yu; Yang, Zhili

doi:10.1111/cen.14455

Cited by 16 publications

(17 citation statements)

References 26 publications

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“…Although many studies have identified nodal disease as a poor prognostic factor for long-term patient survival, this remains controversial (20,21). Some scholars (22)(23)(24)(25) advocate routine CLND to prevent a future recurrence.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Zhang

Wang

et al. 2022

Front. Oncol.

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IntroductionIdentifying risk variables for cervical lymph node metastases in multifocality papillary thyroid cancer (MPTC) could assist surgeons in determining whether cervical lymph node dissection would be an appropriate surgical option.MethodsA retrospective cohort of 2006 patients with papillary thyroid cancer were selected. MPTC (N = 460) was defined as the presence of two or more foci of PTC. The risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in MPTC were investigated by univariate and multivariate analyses, including the following items: age at diagnosis, gender, Hashimoto’s thyroiditis, extrathyroidal extension (ETE), maximal axial diameter (MAD) and the sum of axial diameters (SAD) of tumor. In addition, CLNM was used to evaluate LLNM.ResultsThe incidence of CLNM and LLNM was 44.57% and 17.17%, respectively. The multivariate analysis demonstrated that gender, extrathyroidal extension (ETE), age, maximal axial diameter (MAD), and the sum of axial diameters (SAD) were related to increased risk for CLNM in MPTC (p < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for age at diagnosis of CLNM was 0.647, the cut-off value was 50 years old. Additionally, by multivariate analysis, CLNM, ETE, MAD, and SAD were independent risk factors for LLNM in MPTC (p < 0.05). ROC curve analysis demonstrates that AUC for MAD and SAD diagnosis of LLNM were 0.639 and 0.757, and the cut-off values were 16 and 26 mm, respectively.ConclusionsMPTC patients who have risk factors for CLNM were advised to perform prophylactic central lymph node dissection (CLND). Additionally, the presence of risk factors for LLNM should be individually evaluated and analyzed for the necessity of lateral lymph node dissection.

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Section: Discussionmentioning

confidence: 99%

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Zhang

Wang

et al. 2022

Front. Oncol.

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“…An appropriate patient selection remains one of the decisive factors for the success of the therapy. In this context, studies unquestionably demonstrated a more aggressive tumor biology in the case of multifocal PTMC [ 2 , 10 , 13 , 16 , 26 ]. In line with this, we demonstrated a significant impact of the summarized tumor size on the prediction of bilateral carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Bilateral Disease in Papillary Microcarcinoma: A Retrospective Cohort Study

Lindner

Iwen

Kußmann³

et al. 2022

Current Oncology

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Background: Based on risk stratification, the therapeutic options in papillary microcarcinoma (PTMC) can be active surveillance or surgery. Multifocal tumor occurrence can be decisive in determining the treatment strategy. The objective of this study was to identify risk factors for bilateral tumor occurrence in PTMC to enable individual therapy planning. Methods: A total of 545 PTMC patients who underwent thyroidectomy from 2008 to 2020 were retrieved. Univariate and multivariate analyses were performed to evaluate risk factors for bilateral PTMC. Results: 25.1% (n = 137) of all patients had multifocal PTMC, and 13.2% (n = 72) bilateral PTMC, respectively. In contrast to the maximum tumor size, the total tumor size significantly influenced a bilateral tumor manifestation (median total tumor size 5 mm versus 8.5 mm for bilateral PTMC, p < 0.001). A cut-off level for the total tumor size of >10 mm resulted in a sensitivity and specificity of 29.2% and 94.7%, respectively, in predicting a bilateral tumor manifestation, AUC 0.680 (95% CI, 0.611–0.748, p < 0.001). A cut-off of >4 tumors showed a sensitivity of 99.4% and a specificity of 97.5%, AUC 0.897 (95% CI, 0.870–0.924, p < 0.001) in predicting bilaterality. Conclusion: We could demonstrate for the first time that a total tumor size of >10 mm and more than four tumors significantly increased the risk of bilateral PTMC tumor involvement. These findings enable a risk-adjusted patient treatment.

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“…[ 20 ] Nonetheless, the long-term outcomes remain favorable in those with bilateral multifocal than unifocal disease, with a similar recurrence risk after a median follow-up of 60 months. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital

Aldahmani

Malik

Aziz

et al. 2022

Saudi J Med Med Sci

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Background: Recent guidelines in the management of papillary thyroid microcarcinoma (PTMC) recommend limiting surgery. However, trends in the characteristics and management of PTMC from the Middle East and North Africa region is lacking. Objectives: To determine the clinical features, management strategy, and outcomes of PTMC in a large tertiary care center in the United Arab Emirates (UAE). Patients and Methods: This retrospective study included all patients diagnosed with PTMC (i.e., size ≤10 mm) at Tawam Hospital, Al Ain, UAE, between 2008 and 2019. Tumor histopathology, management strategy, and outcomes were the primary analyzed variables. Results: A total of 213 patients with PTMC met the inclusion criteria, of which 83.6% were women and 58.7% were Emiratis. The majority had the classical tumor subtype (76.1%) and tumor of size 5–10 mm (71.4%). Multifocal disease was present in 41.1% and lymph node metastasis (LNM) in 16.6% of the patients. According to the 2015 American Thyroid Association categorization, the majority (93.9%) had a low-risk disease, and all except one patient had Stage 1 disease. Total thyroidectomy was performed in 91.1% of the patients, and 47.9% received radioiodine (RAI) therapy. None of the patients were under active surveillance strategy. RAI treatment was used more often in patients with non-incidental tumors, larger tumor size, multifocal disease, positive LNM, tumors in the intermediate/high ATA category, and those who underwent total thyroidectomy or neck dissection (for all, P < 0.05). After a median follow-up of 32.4 months, about 73% had an excellent response to dynamic risk stratification assessment, and only one patient had disease recurrence. Conclusions: The majority of the patients had low-risk PTMC, yet most patients underwent total thyroidectomy, and almost 50% were treated with RAI ablation. Further studies are needed to determine if these trends are also present regionally and to explore reasons for not adopting a less aggressive approach in this indolent tumor.

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Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis

Cited by 16 publications

References 26 publications

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer

Predictive Factors for Bilateral Disease in Papillary Microcarcinoma: A Retrospective Cohort Study

Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital

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