Annals of Surgical Oncology

, Volume 22, Issue 1, pp 125–131 | Cite as

Prognostic Significance of Tumor Multifocality in Papillary Thyroid Carcinoma and its Relationship with Primary Tumor Size: A Retrospective Study of 2,309 Consecutive Patients

  • Kuk-Jin Kim
  • Seok-Mo Kim
  • Yong Sang Lee
  • Woong Youn Chung
  • Hang-Seok Chang
  • Cheong Soo Park
Endocrine Tumors

Abstract

Background

Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC), but its prognostic value is controversial. We investigated the prognostic significance of multifocality in PTCs larger than 1 cm and papillary thyroid microcarcinomas (PTMC).

Methods

Medical records and pathologic results of 2,309 patients who received thyroidectomy and lymph node dissection for PTC were retrospectively reviewed. We identified 648 patients who had PTC with a primary tumor exceeding 1 cm, and 1,661 patients with PTMC. In each group, we compared patients with unifocal and multifocal disease. Cox regression analyses of disease persistence and recurrence were performed to identify the prognostic significance of multifocality.

Results

The mean follow-up period was 5.6 years. In the analyses of PTCs larger than 1 cm, the multifocal group included more extensive thyroid surgeries (p = 0.039), radioactive iodine therapies with higher doses (p < 0.001), and significantly higher rates of disease persistence and recurrence (p = 0.001) compared with the unifocal group. In analogous analyses of patients with PTMC, disease persistence and recurrence did not differ significantly between the unifocal and multifocal groups. Cox regression analyses indicated that multifocality was an independent risk factor for disease persistence and recurrence in patients who had PTC with a tumor exceeding 1 cm, but not in patients with PTMC.

Conclusion

Tumor multifocality appears to be an important prognostic factor for PTCs larger than 1 cm, but may have little or no prognostic significance for PTMC.

Keywords

Papillary Thyroid Carcinoma Total Thyroidectomy Primary Tumor Size Tumor Multifocality Completion Thyroidectomy 

Notes

Disclosures

Kuk-Jin Kim, Seok-Mo Kim, Yong Sang Lee, Woong Youn Chung, Hang-Seok Chang, and Cheong Soo Park declare that they have no conflicts to report.

References

  1. 1.
    Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297–306.PubMedCrossRefGoogle Scholar
  2. 2.
    Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86:1447–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Caron NR, Clark OH. Well differentiated thyroid cancer. Scand J Surg. 2004;93:261–71.PubMedGoogle Scholar
  4. 4.
    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  5. 5.
    Low TH, Delbridge L, Sidhu S, et al. Lymph node status influences follow-up thyroglobulin levels in papillary thyroid cancer. Ann Surg Oncol. 2008;15:2827–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Schlumberger M, Pacini F, Wiersinga WM, et al. Follow-up and management of differentiated thyroid carcinoma: a European perspective in clinical practice. Eur J Endocrinol. 2004;151:539–48.PubMedCrossRefGoogle Scholar
  7. 7.
    Cobin RH, Gharib H, Bergman DA, et al. AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. American College of Endocrinology. Endocr Pract. 2001;7:202–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Cross S, Wei JP, Kim S, Brams DM. Selective surgery and adjuvant therapy based on risk classifications of well-differentiated thyroid cancer. J Surg Oncol. 2006;94:678–82.PubMedCrossRefGoogle Scholar
  9. 9.
    McCarthy RP, Wang M, Jones TD, Strate RW, Cheng L. Molecular evidence for the same clonal origin of multifocal papillary thyroid carcinomas. Clin Cancer Res. 2006;12:2414–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Wang W, Wang H, Teng X, et al. Clonal analysis of bilateral, recurrent, and metastatic papillary thyroid carcinomas. Hum Pathol. 2010;41:1299–309.PubMedCrossRefGoogle Scholar
  11. 11.
    Shattuck TM, Westra WH, Ladenson PW, Arnold A. Independent clonal origins of distinct tumor foci in multifocal papillary thyroid carcinoma. N Eng J Med. 2005;352:2406–12.CrossRefGoogle Scholar
  12. 12.
    Kuhn E, Teller L, Piana S, Rosai J, Merino MJ. Different clonal origin of bilateral papillary thyroid carcinoma, with a review of the literature. Endocr Pathol. 2012;23:101–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Mazeh H, Samet Y, Hochstein D, et al. Multifocality in well-differentiated thyroid carcinomas calls for total thyroidectomy. Am J Surg. 2011;201:770–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Pitts SC. Sippel RS, Chen H. Contralateral papillary thyroid cancer: dose size matter? Am J Surg. 2009;197:342–7.CrossRefGoogle Scholar
  15. 15.
    Pedrazzini L, Baroli A, Marzoli L, Guglielmi R, Papini E. Cancer recurrence in papillary thyroid microcarcinoma: a multivariate analysis on 231 patients with a 12-years follow-up. Minerva Endocrinol. 2013;38:269–79.PubMedGoogle Scholar
  16. 16.
    Wu AW, Wang MB, Nguyen CT. Surgical practice patterns in the treatment of papillary thyroid microcarcinoma. Arch Otolaryngol Head Neck Surg. 2010;136:1182–90.PubMedCrossRefGoogle Scholar
  17. 17.
    Edge SB, Byrd DR, Carducci M, et al. AJCC Cancer Staging manual, 7th edition. New York: Springer; 2010: pp 87–96.Google Scholar
  18. 18.
    Kim HJ, Sohn SY, Jang HW, et al. Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J Surg. 2013;37:376–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Ricci JA, Alfonso AE. Multifocal micropapillary thyroid cancer: a new indication for total thyroidectomy? Am Surg. 2012;78:1211–4.PubMedGoogle Scholar
  20. 20.
    Zhao Q, Ming J, Liu C, et al. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol. 2013;20:746–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Vasileiadis I, Karakostas E, Charitoudis G, et al. Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients. Eur J Clin Investig. 2012;42:657–64.CrossRefGoogle Scholar
  22. 22.
    He Q, Zhuang D, Zheng L, et al. The surgical management of papillary thyroid microcarcinoma: a 162-month single-center experience of 273 cases. Am Surg. 2012;78:1215–8.PubMedGoogle Scholar
  23. 23.
    Schindler AM, van Melle G, Evequoz B, Scazziga B. Prognostic factors in papillary carcinoma of the thyroid. Cancer. 1991;68:324–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Leboulleux S, Rubino C, Baudin E, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005;90:5723–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Ross DS, Litofsky D, Ain KB, et al. Recurrence after treatment of micropapillary thyroid cancer. Thyroid. 2009;19:1043–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Neuhold N, Schultheis A, Hermann M, Krotla G, Koperek O, Birner P. Incidental papillary microcarcinoma of thyroid–further evidence of very low malignant potential: a retrospective clinicopathological study with up to 30 years of follow-up. Ann Surg Oncol. 2011;18:3430–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Grogan RH, Kaplan SP, Cao H, et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up. Surgery. 2013;154:1436–47.PubMedCrossRefGoogle Scholar
  28. 28.
    Karatzas T, Vasileiadis I, Kapetanakis S, et al. Risk factors contributing to the difference in prognosis for papillary versus micropapillary thyroid carcinoma. Am J Surg. 2013;206:586–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Londero SC, Krogdahl A, Bastholt L, et al. Papillary thyroid microcarcinoma in Denmark 1996-2008: a national study of epidemiology and clinical significance. Thyroid. 2013;23:1159–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Kuk-Jin Kim
    • 1
  • Seok-Mo Kim
    • 1
  • Yong Sang Lee
    • 1
  • Woong Youn Chung
    • 1
  • Hang-Seok Chang
    • 1
  • Cheong Soo Park
    • 1
  1. 1.Thyroid Cancer Center, Department of Surgery, Gangnam Severance HospitalYonsei University College of MedicineSeoulKorea

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