Markovic, Ivan1,2; Santrac, Nada2; Goran, Merima2; Buta, Marko1, 2; Jevric, Marko2; Pupic, Gordana3; Petrovic, Nevena2; Markovic, Marija2; Dzodic, Radan1, 2
1 Medical Faculty, University of Belgrade, Belgrade, Serbia
2 Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
3 Department of Pathology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Background: The incidence of multifocality of papillary thyroid carcinoma (PTC) ranges from 18 to 87.5%. The mechanisms of multifocal spreading, correlation with tumor size, histology variants of PTC, lymph node metastases, and prognostic impact remains unclear .
Purpose: Multivariate analysis of prognostic factors in PTC.
Methods: 153 patients with PTC were included. Patients with pT4 tumors or initially distant metastases were excluded from study. Total thyroidectomy was done in all 153 patients. Central and level III and IV lateral neck lymph node dissection was done in 76.5% patients, followed with modified radical neck dissection if positive.
Results: Multifocality was found in 43 (28%) whole thyroid gland specimens, and was significantly more frequent in patients older than 45 years and in tumors greater than 4 cm in diameter (p<0.01). Presence of multifocality did not significantly correlate with gender, histology variants of PTC or lymph node metastases. In a median follow-up of 84 months, locoregional relapse occurred in 8.4% and 1.3% of patients, while 7.2% patients died due to PTC. The incidence of relapse was significantly higher (p<0.01), and relapse-free interval and survival were significantly shorter (p=0.0095, p=0.0004, respectively) in patients with multifocal PTC. Cox`s multivariate regression analysis showed that multifocality was independent prognostic factor for both relapse-free and overall survival of patients with PTC.
Discussion & Conclusion: Due to high incidence of multifocality and potential prognostic impact, total thyroidectomy should be advocated in all patients with PTC, aiming to reduce relapse rate and improve relapse-free interval and overall survival [2-4].
1. Mazzaferri EL. Long-term outcome of patients with differentiated thyroid carcinoma: effect of therapy. Endocr Pract 2000; 6(6):469-476
2. Ricci J.A., Alfonso A.E. Multifocal micropapillary thyroid cancer: a new indication for total thyroidectomy. Am Surg. 2012; 78(11):1211–1214.
3. Jung-Soo P, Jin HS, Guhyun K. Ddetection of tumor multifocality is important for prediction of tumor recurrence in papillary thyroid microcarcinoma: a retrospective study and meta-analysis. J Pathol Transl Med. 2016; 50(4): 278–286.
4. Kim KJ, Kim SM, Lee YS, Chung WY, Chang HS, Park CS. Prognostic significance of tumor multifocality in papillary thyroid carcinoma and its relationship with primary tumor size: a retrospective study of 2,309 consecutive patients. Ann Surg Oncol. 2015; 22(1):125-131.