期刊
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
卷 102, 期 9, 页码 3241-3250出版社
ENDOCRINE SOC
DOI: 10.1210/jc.2017-00277
关键词
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资金
- U.S. National Institutes of Health (NIH) [R01CA113507, R01CA189224]
- Polish National Center of Research and Development MILESTONE Project: Molecular Diagnostics and Imaging in Individualized Therapy for Breast, Thyroid, and Prostate Cancer [STRATEGMED2/267398/4/NCBR/2015]
- Menzies Health Institute, Queensland
- Queensland Smart State fellowship (Australia) [SAF2013-44709-R, RD12/0036/0030, PI14/01980, GCB14142311CRES]
- Fondazione Cassa di Risparmio di Perugia [IG 9338]
- Associazione Italiana per la Ricerca sul Cancro (Italy)
- Beadle Family Foundation (San Antonio) [AZV 16-32665A]
- MHCZ-DRO (Institute of Endocrinology-EU) [00023761]
- New South Wales Cancer Institute
- Cancer Council of New South Wales (Australia)
- NIH/National Institute on Aging [5R03AG042334-02]
- Ministero della Istruzione Universitaria e Ricerca Scientifica
- Associazione Italiana per la Ricerca sul Cancro
- Istituto Toscano Tumori
- Ministero della Salute (Italy)
- Health Department of Shandong Province [2013 WS0266]
- Innovative Platform Project of Qingdao (China) [12-1-2-15-jch]
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.
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