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.
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References
Ning Qu, Ling Z, Qing-hai J, Yong-xue Z, Zhuo-ying W, Qiang S, Yu W et al (2014) Number of tumor foci predicts prognosis in papillary thyroid cancer. BMC Cancer 14(1):914
Nixon IJ, Shaha AR, Patel SG (2014) Surgical diagnosis: frozen section and the extent of surgery. Otolaryngol Clin North Am Erica 47(4):519–528
Schonberger J, Marienhagen J, Agha A, Rozeboom S, Bachmeier E, Schlitt H et al (2007) Papillary microcarcinoma and papillary cancer of the thyroid ≤1 cm: modified definition of the WHO and the therapeutic dilemma. Nuklearmedizin 46:115–120
Sciuto R, Romano L, Rea S, Marandino F, Sperduti I, Maini CL (2009) Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution. Ann Oncol 20(10):1728–1735
Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–987 (discussion 987–988)
Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K et al (2008) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28(11):1115–1121
Wang W, Wang H, Teng X, Wang H, Mao C, Teng R et al (2010) Clonal analysis of bilateral, recurrent, and metastatic papillary thyroid carcinomas. Hum Pathol 41:1299–1309
Kim HJ, Sohn SY, Jang HW, Kim SW, Chung JH (2013) Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg 37(2):376–384
Zhou Y-L, Gao E, Zhang W, Han Y, Gui-Long G, Xiao-Hua Z et al (2012) Factors predictive of papillary thyroid micro-carcinoma with bilateral involvement and central lymph node metastasis: a retrospective study. World J Surg Oncol 10:67
Kim HJ, Park HK, Byun DW, Suh K, Yoo MH, Min YK et al (2015) Number of tumor foci as predictor of lateral lymph node metastasis in papillary thyroid carcinoma. Head Neck 37(5):650–654
Chow SM, Law SC, Chan JK, Au SK, Yau S, Lau WH (2003) Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer 98(1):31–40
Riss JC, Peyrottes I, Chamorey E, Haudebourg J, Sudaka A, Benisvy D et al (2012) Prognostic impact of tumour multifocality in thyroid papillary microcarcinoma based on a series of 160 cases. Eur Ann Otorhinolaryngol Head Neck Dis 129(4):175–178
Kim KJ, Kim SM, Lee YS, Chung WY, Chang HS, Park CS (2015) Prognostic significance of tumor multifocality in papillary thyroid carcinoma and its relationship with primary tumor size: a retrospective study of 2309 consecutive patients. Ann Surg Oncol 22(1):125–131
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6):1471–1474
Mantinan B, Rego-Iraeta A, Larrañaga A, Fluiters E, Sánchez-Sobrino P, Garcia-Mayor RV (2012) Factors influencing the outcome of patients with incidental papillary thyroid microcarcinoma. J Thyroid Res 2012:469397
Hassan A, Razi M, Riaz S, Khalid M, Nawaz MK, Syed AA et al (2016) Survival analysis of papillary thyroid carcinoma in relation to stage and recurrence risk: a 20-year experience in Pakistan. Clin Nucl Med 41(8):606–613
Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S et al (2009) Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 19:707–716
Kuo SF, Lin SF, Chao TC, Hsueh C, Lin KJ, Lin JD (2013) Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol 2013:809382
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133
Connor MP, Wells D, Schmalbach CE (2011) Variables predictive of bilateral occult papillary microcarcinoma following total thyroidectomy. Otolaryngol Head Neck Surg 144(2):210–215
Khan M, Syed AA, Khan AI, Syed RH, Zafar W (2015) Morbidity comparison of primary and completion total thyroidectomy for differentiated thyroid cancer in relation to the extent of redo surgery. Int J Surg Open 1:14–17. doi:10.1016/j.ijso.2016.02.003
Ross DS, Litofsky D, Ain KB, Bigos T, Brierley JD, Cooper DS et al (2009) Recurrence after treatment of micropapillary thyroid cancer. Thyroid 19(10):1043–1048
Acknowledgements
The authors thank Dr. Farhana Badar, clinical research scientist for her help in the statistical analysis and Dr. Sana Syed Assistant Professor of Neurology at Tufts Medical Center and Clinical Translational Research Fellow at Pfizer for the help in draft editing.
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Khan, M., Syed, A.A., Khan, A.I. et al. 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. Updates Surg 70, 121–127 (2018). https://doi.org/10.1007/s13304-017-0465-5
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DOI: https://doi.org/10.1007/s13304-017-0465-5