The prognostic value of tumor multifocality in clinical outcomes of papillary thyroid cancer

Fei Wang, Xiaolong Yu, Xiaopei Shen, Guangwu Zhu, Yueye Huang, Rengyun Liu, David Viola, Rossella Elisei, Efisio Puxeddu, Laura Fugazzola, Carla Colombo, Barbara Jarzab, Agnieszka Czarniecka, Alfred K. Lam, Caterina Mian, Federica Vianello, Linwah Yip, Garcilaso Riesco-Eizaguirre, Pilar Santisteban, Christine J. O'NeillMark S. Sywak, Roderick Clifton-Bligh, Bela Bendlova, Vlasta Sýkorová, Yangang Wang, Shiguo Liu, Jiajun Zhao, Shihua Zhao, Mingzhao Xing

Research output: Contribution to journalArticle

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 to 58) years and median (IQR) follow-up time of 58 (26 to 107) months at 11 medical centers in six countries. Surveillance, Epidemiology and End Results (SEER) data were used for validation. Results: Disease recurrence in multifocal and unifocal PTC was 198 of 1000 (19.8%) and 221 of 1624 (13.6%) (P , 0.001), with a hazard ratio of 1.55 [95% confidence interval (CI), 1.28 to 1.88], which became insignificant at 1.13 (95% CI, 0.93 to 1.37) on 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 classic risk factors and cancer recurrence or mortality, which remained significant after multivariate adjustment. In 1423 patients with intrathyroidal PTC, disease recurrence was 20 of 455 (4.4%) and 41 of 967 (4.2%) (P = 0.892) and mortality was 0 of 455 (0.0%) and 3 of 967 (0.3%) (P = 0.556) in multifocal and 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 indiscriminate use as an independent risk factor, prompting overtreatments of patients, should be avoided.

Original languageEnglish (US)
Pages (from-to)3241-3250
Number of pages10
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number9
DOIs
StatePublished - Sep 1 2017

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    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, A. K., Mian, C., Vianello, F., Yip, L., Riesco-Eizaguirre, G., Santisteban, P., ... Xing, M. (2017). The prognostic value of tumor multifocality in clinical outcomes of papillary thyroid cancer. Journal of Clinical Endocrinology and Metabolism, 102(9), 3241-3250. https://doi.org/10.1210/jc.2017-00277