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

• Published in: Updates in surgery Vol. 70; no. 1; pp. 121 - 127
• Main Authors: Khan, Misbah, Syed, Aamir Ali, Khan, Amina Iqbal, Hussain, Syed Raza, Urooj, Namra
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.03.2018
• Subjects: Adolescent; Adult; Aged; Carcinoma, Papillary - pathology; Carcinoma, Papillary - therapy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Iodine Radioisotopes - therapeutic use; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; Original Article; Radiopharmaceuticals - therapeutic use; Retrospective Studies; Risk Factors; Surgery; Thyroid Cancer, Papillary; Thyroid Neoplasms - pathology; Thyroid Neoplasms - therapy; Thyroidectomy; Thyroxine - therapeutic use; Treatment Outcome; Tumor Burden; Young Adult; Micro-papillary thyroid cancer; Recurrence free survival; Thyroid cancer; Tumor recurrence; Multifocal papillary
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-017-0465-5

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.