A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer
Multifocality is increasingly observed in papillary thyroid carcinoma (PTC) due to improvements in imaging and histopathological analysis. However, its significance in management, particularly as a sole risk-factor, remains controversial. This study aimed to investigate the prognostic value of multi...
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| Veröffentlicht in: | European journal of surgical oncology 2022-01, Vol.48 (1), p.14-20 |
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| creator | Li, Lucy Qian Hey, Shi Ying Andreeva, Daria Tornari, Chrysostomos Sawant, Rupali Harding, Noah Evans Adamson, Richard Hay, Ashley Simo, Ricard Nixon, Iain James |
| description | Multifocality is increasingly observed in papillary thyroid carcinoma (PTC) due to improvements in imaging and histopathological analysis. However, its significance in management, particularly as a sole risk-factor, remains controversial. This study aimed to investigate the prognostic value of multifocality in predicting recurrence following thyroid lobectomy in a contemporary group of PTC patients managed in the UK.
Patients with PTC in NHS Lothian (2009-19) and Guys and St Thomas NHS Foundation Trust (2012-19) were identified. Categorical variables were compared using Chi-squared or Fisher's exact test. Five-year recurrence free survival (RFS) were analysed using Kaplan-Meier method and compared using log-rank.
Of 828 patients; 492 (59%) had unifocal and 336 (41%) multifocal disease on final pathology. A higher rate of pathological nodal disease (22%v36%,p |
| doi_str_mv | 10.1016/j.ejso.2021.06.033 |
| format | Article |
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Patients with PTC in NHS Lothian (2009-19) and Guys and St Thomas NHS Foundation Trust (2012-19) were identified. Categorical variables were compared using Chi-squared or Fisher's exact test. Five-year recurrence free survival (RFS) were analysed using Kaplan-Meier method and compared using log-rank.
Of 828 patients; 492 (59%) had unifocal and 336 (41%) multifocal disease on final pathology. A higher rate of pathological nodal disease (22%v36%,p < 0.001), total thyroidectomy (TT) (78%v92%,p < 0.001) and radioactive iodine (RAI) (57%v75%,p < 0.001) was demonstrated in patients with multifocality. With a median follow-up of 50 months, overall 5-year RFS was 96.5%; 96.5% for unifocal versus 96.6% for multifocal disease (p = 0.695). Recurrence was not shown to be associated with multifocality on either univariate or multivariate analysis. Amongst patients with T1/2N0M0 disease (n = 341), more patients were treated with TT and RAI with multifocal compared to unifocal disease (<0.001). Only two patients within this group recurred during follow up, both of whom had multifocal disease and were treated with TT and RAI (5yRFS100%v98.1%,p = 0.051).
Multifocality is a common feature of PTC but does not appear to be an independent predictor of outcome. Therefore, treatment intensification on the basis of multifocality alone seems unwarranted.
•The significance of multifocality, particularly as a sole risk factor, in the management of papillary thyroid cancer (PTC) is unclear•Patients have excellent outcomes where multifocality is the only potential adverse risk factor (T1/2N0 disease)•Clinicians should take an individualised approach to treatment that balances a small chance of oncological benefit with the risks for harm associated with further surgery, with or without radioactive iodine, if multifocal disease is identified</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2021.06.033</identifier><identifier>PMID: 34253424</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Disease-Free Survival ; Female ; Humans ; Iodine Radioisotopes - therapeutic use ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multifocality ; Neck Dissection - methods ; Neoplasm Invasiveness ; Neoplasms, Multiple Primary - pathology ; Neoplasms, Multiple Primary - surgery ; Papillary thyroid carcinoma ; Prognosis ; Proportional Hazards Models ; Recurrence ; Thyroid Cancer, Papillary - pathology ; Thyroid Cancer, Papillary - surgery ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - surgery ; Thyroidectomy - methods ; United Kingdom</subject><ispartof>European journal of surgical oncology, 2022-01, Vol.48 (1), p.14-20</ispartof><rights>2021</rights><rights>Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-b4ca552cd68fc2d2b1597155766197353cbd5e9e3d4d5d045f4275ed0ceff8843</citedby><cites>FETCH-LOGICAL-c400t-b4ca552cd68fc2d2b1597155766197353cbd5e9e3d4d5d045f4275ed0ceff8843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejso.2021.06.033$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34253424$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Lucy Qian</creatorcontrib><creatorcontrib>Hey, Shi Ying</creatorcontrib><creatorcontrib>Andreeva, Daria</creatorcontrib><creatorcontrib>Tornari, Chrysostomos</creatorcontrib><creatorcontrib>Sawant, Rupali</creatorcontrib><creatorcontrib>Harding, Noah Evans</creatorcontrib><creatorcontrib>Adamson, Richard</creatorcontrib><creatorcontrib>Hay, Ashley</creatorcontrib><creatorcontrib>Simo, Ricard</creatorcontrib><creatorcontrib>Nixon, Iain James</creatorcontrib><title>A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Multifocality is increasingly observed in papillary thyroid carcinoma (PTC) due to improvements in imaging and histopathological analysis. However, its significance in management, particularly as a sole risk-factor, remains controversial. This study aimed to investigate the prognostic value of multifocality in predicting recurrence following thyroid lobectomy in a contemporary group of PTC patients managed in the UK.
Patients with PTC in NHS Lothian (2009-19) and Guys and St Thomas NHS Foundation Trust (2012-19) were identified. Categorical variables were compared using Chi-squared or Fisher's exact test. Five-year recurrence free survival (RFS) were analysed using Kaplan-Meier method and compared using log-rank.
Of 828 patients; 492 (59%) had unifocal and 336 (41%) multifocal disease on final pathology. A higher rate of pathological nodal disease (22%v36%,p < 0.001), total thyroidectomy (TT) (78%v92%,p < 0.001) and radioactive iodine (RAI) (57%v75%,p < 0.001) was demonstrated in patients with multifocality. With a median follow-up of 50 months, overall 5-year RFS was 96.5%; 96.5% for unifocal versus 96.6% for multifocal disease (p = 0.695). Recurrence was not shown to be associated with multifocality on either univariate or multivariate analysis. Amongst patients with T1/2N0M0 disease (n = 341), more patients were treated with TT and RAI with multifocal compared to unifocal disease (<0.001). Only two patients within this group recurred during follow up, both of whom had multifocal disease and were treated with TT and RAI (5yRFS100%v98.1%,p = 0.051).
Multifocality is a common feature of PTC but does not appear to be an independent predictor of outcome. Therefore, treatment intensification on the basis of multifocality alone seems unwarranted.
•The significance of multifocality, particularly as a sole risk factor, in the management of papillary thyroid cancer (PTC) is unclear•Patients have excellent outcomes where multifocality is the only potential adverse risk factor (T1/2N0 disease)•Clinicians should take an individualised approach to treatment that balances a small chance of oncological benefit with the risks for harm associated with further surgery, with or without radioactive iodine, if multifocal disease is identified</description><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Iodine Radioisotopes - therapeutic use</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multifocality</subject><subject>Neck Dissection - methods</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasms, Multiple Primary - pathology</subject><subject>Neoplasms, Multiple Primary - surgery</subject><subject>Papillary thyroid carcinoma</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Recurrence</subject><subject>Thyroid Cancer, Papillary - pathology</subject><subject>Thyroid Cancer, Papillary - surgery</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroidectomy - methods</subject><subject>United Kingdom</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLtO7DAURS0EguHxA7dALmkS_IwTiQahy0Mg0UBtOfYJ16MkHmwPaP7-ejRASXHk4qy9dbwQ-kNJTQltLpc1LFOoGWG0Jk1NON9DCyo5qxiVah8tiBJtpbqWH6HjlJaEkI6r7hAdccFkGbFAb9f49RH3JoHD-TNUFuYcAUf48PCJw4Cn9Zj9EKwZfd5gMzvsc8IxjID9jPM_wIU3eSq5Lb4yKz-OJm7KahODd9ia2UI8RQeDGROcfb0n6PX278vNffX0fPdwc_1UWUFIrnphjZTMuqYdLHOsp7JTVErVNLRTXHLbOwkdcCecdETIQTAlwRELw9C2gp-gi13vKob3NaSsJ58slJNmCOukmZSUUcpaVVC2Q20MKUUY9Cr6qZyuKdFbwXqpt4L1VrAmjS6CS-j8q3_dT-B-It9GC3C1A6D8skiMOlkPRYHzEWzWLvjf-v8DOkOM6A</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Li, Lucy Qian</creator><creator>Hey, Shi Ying</creator><creator>Andreeva, Daria</creator><creator>Tornari, Chrysostomos</creator><creator>Sawant, Rupali</creator><creator>Harding, Noah Evans</creator><creator>Adamson, Richard</creator><creator>Hay, Ashley</creator><creator>Simo, Ricard</creator><creator>Nixon, Iain James</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202201</creationdate><title>A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer</title><author>Li, Lucy Qian ; Hey, Shi Ying ; Andreeva, Daria ; Tornari, Chrysostomos ; Sawant, Rupali ; Harding, Noah Evans ; Adamson, Richard ; Hay, Ashley ; Simo, Ricard ; Nixon, Iain James</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-b4ca552cd68fc2d2b1597155766197353cbd5e9e3d4d5d045f4275ed0ceff8843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Iodine Radioisotopes - therapeutic use</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multifocality</topic><topic>Neck Dissection - methods</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasms, Multiple Primary - pathology</topic><topic>Neoplasms, Multiple Primary - surgery</topic><topic>Papillary thyroid carcinoma</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Recurrence</topic><topic>Thyroid Cancer, Papillary - pathology</topic><topic>Thyroid Cancer, Papillary - surgery</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroidectomy - methods</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Lucy Qian</creatorcontrib><creatorcontrib>Hey, Shi Ying</creatorcontrib><creatorcontrib>Andreeva, Daria</creatorcontrib><creatorcontrib>Tornari, Chrysostomos</creatorcontrib><creatorcontrib>Sawant, Rupali</creatorcontrib><creatorcontrib>Harding, Noah Evans</creatorcontrib><creatorcontrib>Adamson, Richard</creatorcontrib><creatorcontrib>Hay, Ashley</creatorcontrib><creatorcontrib>Simo, Ricard</creatorcontrib><creatorcontrib>Nixon, Iain James</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Lucy Qian</au><au>Hey, Shi Ying</au><au>Andreeva, Daria</au><au>Tornari, Chrysostomos</au><au>Sawant, Rupali</au><au>Harding, Noah Evans</au><au>Adamson, Richard</au><au>Hay, Ashley</au><au>Simo, Ricard</au><au>Nixon, Iain James</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2022-01</date><risdate>2022</risdate><volume>48</volume><issue>1</issue><spage>14</spage><epage>20</epage><pages>14-20</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Multifocality is increasingly observed in papillary thyroid carcinoma (PTC) due to improvements in imaging and histopathological analysis. However, its significance in management, particularly as a sole risk-factor, remains controversial. This study aimed to investigate the prognostic value of multifocality in predicting recurrence following thyroid lobectomy in a contemporary group of PTC patients managed in the UK.
Patients with PTC in NHS Lothian (2009-19) and Guys and St Thomas NHS Foundation Trust (2012-19) were identified. Categorical variables were compared using Chi-squared or Fisher's exact test. Five-year recurrence free survival (RFS) were analysed using Kaplan-Meier method and compared using log-rank.
Of 828 patients; 492 (59%) had unifocal and 336 (41%) multifocal disease on final pathology. A higher rate of pathological nodal disease (22%v36%,p < 0.001), total thyroidectomy (TT) (78%v92%,p < 0.001) and radioactive iodine (RAI) (57%v75%,p < 0.001) was demonstrated in patients with multifocality. With a median follow-up of 50 months, overall 5-year RFS was 96.5%; 96.5% for unifocal versus 96.6% for multifocal disease (p = 0.695). Recurrence was not shown to be associated with multifocality on either univariate or multivariate analysis. Amongst patients with T1/2N0M0 disease (n = 341), more patients were treated with TT and RAI with multifocal compared to unifocal disease (<0.001). Only two patients within this group recurred during follow up, both of whom had multifocal disease and were treated with TT and RAI (5yRFS100%v98.1%,p = 0.051).
Multifocality is a common feature of PTC but does not appear to be an independent predictor of outcome. Therefore, treatment intensification on the basis of multifocality alone seems unwarranted.
•The significance of multifocality, particularly as a sole risk factor, in the management of papillary thyroid cancer (PTC) is unclear•Patients have excellent outcomes where multifocality is the only potential adverse risk factor (T1/2N0 disease)•Clinicians should take an individualised approach to treatment that balances a small chance of oncological benefit with the risks for harm associated with further surgery, with or without radioactive iodine, if multifocal disease is identified</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>34253424</pmid><doi>10.1016/j.ejso.2021.06.033</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Disease-Free Survival Female Humans Iodine Radioisotopes - therapeutic use Kaplan-Meier Estimate Male Middle Aged Multifocality Neck Dissection - methods Neoplasm Invasiveness Neoplasms, Multiple Primary - pathology Neoplasms, Multiple Primary - surgery Papillary thyroid carcinoma Prognosis Proportional Hazards Models Recurrence Thyroid Cancer, Papillary - pathology Thyroid Cancer, Papillary - surgery Thyroid Neoplasms - pathology Thyroid Neoplasms - surgery Thyroidectomy - methods United Kingdom |
| title | A UK based two-centre review of multifocality and its role in the treatment of papillary thyroid cancer |
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