Bilateral multifocality is an independent predictor of patients’ outcome in Middle Eastern papillary thyroid carcinoma

Abstract

BackgroundTumor multifocality is frequently seen in Papillary thyroid carcinoma (PTC). However, few studies have analysed the impact of bilateral multifocality in PTC. The incidence of bilateral multifocality, its clinico-pathological associations and prognostic impact in PTC from Middle Eastern ethnicity remains unestablished.MethodsWe retrospectively evaluated 1283 patients who underwent total thyroidectomy for PTC. Bilateral and unilateral multifocality were decided based on the final pathology result. Primary outcome was recurrence free survival (RFS). Risk factors for bilateral multifocality were analyzed by multivariate logistic regression analysis.ResultsMultifocal PTC was found in 54.3% (697/1283) of patients. Among the 697 multifocal PTCs, 210 patients (30.1%) had unilateral multifocal PTC and 487 patients (69.9%) had bilateral multifocality. Bilateral multifocality was significantly associated with older age at diagnosis (p = 0.0263), male gender (p = 0.0201), gross extrathyroidal extension (p = 0.0332), larger primary tumor size (>4cm; p = 0.0002), lateral lymph node metastasis (p = 0.0008), distant metastasis at diagnosis (p = 0.0195) and recurrence (p = 0.0001). Bilateral multifocality was also found to be an independent predictor of RFS (Hazard ratio = 1.60; 95% Confidence Interval = 1.05 – 2.55; p = 0.0300). Multivariate logistic regression analysis demonstrated tumor diameter >4cm to be the only independent risk factors for bilaterality in multifocal PTC (Odds ratio = 1.86; 95% Confidence Interval = 1.13 – 3.07; p = 0.0155).ConclusionsIncidence of bilateral multifocality is high in Middle Eastern PTC. Tumor diameter >4cm can be considered as a predictive factor for bilateral multifocal PTC. Bilateral multifocality appears to be an important prognostic factor for PTC and an independent predictor of RFS. Therefore, patients with bilateral multifocal PTC may benefit from more frequent follow-up to identify recurrences earlier.

Risk factors for cervical lymph node metastasis of papillary thyroid cancer in elderly patients aged 65 and older

“…In this study, elderly PTC patients with microcalcifications had a LLNM incidence of 24.5%, significantly higher than those without this risk feature. For elderly PTC patients with existing CLNM, bilateral lesions are a significant LLNM risk factor that should not be overlooked, consistent with findings from multiple studies ( 34 , 35 ). In this study, 14 elderly PTC patients developed LLNM in the absence of CLNM, which accounts for nearly 25% of LLNM cases, aligning with previous research findings ranging from 5% to 25% ( 36 , 37 ), this underscores the importance of preoperative assessment and warrants further investigation into the necessity of central compartment dissection in this subgroup.…”

Bilaterality as a Risk Factor for Recurrence in Papillary Thyroid Carcinoma

“…Recent guidelines and consensus statements recommended thyroid lobectomy in the majority of patients with PTC, although total thyroidectomy should be performed for bilateral thyroid cancer [18,25]. Previous reports indicated that bilaterality was associated with aggressive clinicopathologic features, including a larger tumor diameter, ETE, and LN metastasis, as well as a higher TNM stage at presentation [14,26]. In contrast, Kim et al indicated that the clinicopathologic characteristics were not significantly different between the patients with multifocal-bilateral and multifocal-unilateral PTC [12].…”