The Prognostic Value of Tumor Multifocality in Clinical Outcomes of Papillary Thyroid Cancer.

The Prognostic Value of Tumor Multifocality in Clinical Outcomes of Papillary Thyroid Cancer.

J Clin Endocrinol Metab. 2017 Jun 05;:

Authors: Wang F, Yu X, Shen X, Zhu G, Huang Y, Liu R, Viola D, Elisei R, Puxeddu E, Fugazzola L, Colombo C, Jarzab B, Czarniecka A, Lam AK, Mian C, Vianello F, Yip L, Riesco-Eizaguirre G, Santisteban P, O'Neill CJ, Sywak MS, Clifton-Bligh R, Bendlova B, Sýkorová V, Wang Y, Liu S, Zhao J, Zhao S, Xing M

Abstract
Context: Multifocality is often treated as a risk factor for papillary thyroid cancer (PTC), prompting aggressive treatments, but its prognostic value remains unestablished.
Objective: To investigate the role of tumor multifocality in clinical outcomes of PTC.
Methods: Multicenter study of the relationship between multifocality and clinical outcomes of PTC in 2638 patients (623 men and 2015 women) with median (interquartile range [IQR]) age of 46 (35-58) years and median (IQR) follow-up time of 58 (26-107) months at 11 medical centers in 6 countries. SEER data was used for validation.
Results: Disease recurrence in multifocal versus unifocal PTC was 198/1000 (19.8%) versus 221/1624 (13.6%) (P<.001), with a hazard ratio (HR) of 1.55 (95% confidence interval [CI], 1.28-1.88), which became insignificant at 1.13 (95% CI, 0.93-1.37) upon multivariate adjustment. Similar results were obtained in PTC variants-conventional PTC, follicular-variant PTC, tall-cell PTC, and papillary thyroid microcarcinoma. There was no association between multifocality and mortality in any of these PTC settings, whereas there was a strong association between classical risk factors and cancer recurrence/mortality, which remained significant after multivariate adjustment. In 1423 patients with intrathyroidal PTC, disease recurrence was 20/455 (4.4%) versus 41/967 (4.2%) (P=.892) and mortality was 0/455 (0.0%) versus 3/967 (0.3%) (P=.556) in multifocal versus unifocal PTC, respectively. The results were reproduced in 89 680 patients with PTC in the SEER database.
Conclusions: Tumor multifocality has no independent risk prognostic value in clinical outcomes of PTC; its indiscriminative use as an independent risk factor prompting overtreatments of patients should be avoided.

PMID: 28582521 [PubMed - as supplied by publisher]

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