Multifocality Tied to Increased Risk of Papillary Thyroid Cancer Recurrence, but Not Survival

NEW YORK (Reuters Health) – In patients with papillary thyroid cancer (PTC), multifocality was associated with an increased risk of recurrence, but did not impact survival, in a systematic review and meta-analysis.

Multifocality in thyroid cancer is the simultaneous presence of more than one tumor focus within the thyroid gland.

As reported in JAMA Otolaryngology-Head and Neck Surgery, Dr. Hyungju Kwon of Ewha Womans University Medical Center in Seoul and colleagues searched the literature through June 2020 for studies that compared tumor recurrence rates in patients with multifocal versus unifocal PTCs.

The primary outcome was tumor recurrence and the secondary outcome was cancer-specific survival.

Among 26 studies including close to 34,000 patients, the median rate of multifocality was 28.1%. The recurrence rate ranged from 2.7% to 46.4%, with an average rate of 8% over a median follow-up period of 6.6 years.

Recurrence rates were significantly higher in patients with multifocal PTC than in those with unifocal PTC (pooled HR, 1.81).

However, cancer-specific survival was comparable between the groups (HR, 1.19) over a median follow-up of 16.6 years.

In subgroup analyses, the HRs of multifocality for recurrence were associated with primary tumor size (HRs for PTC 1 cm and >1 cm were 1.81 and 1.90, respectively); number of tumor foci (2 foci, HR 1.45; 3 or more foci, 1.95); and patient age (pediatric, HR 3.19; adult, 1.89).

The authors conclude, “Differences in tumor size, number of tumor foci, and patient age should be considered when interpreting the multifocality and the risk of recurrence.”

SOURCE: JAMA Otolaryngology-Head and Neck Surgery, online August 19, 2021.

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