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Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer.

Abstract The multifocal papillary thyroid cancer (PTC), with more aggressive and poorer prognosis, is not rare in papillary histotype. Few studies evaluated risk factors and lymph node metastasis in multifocal PTC. The aim of this present study focusing on risk factors and lymph node metastasis characteristics in multifocal PTC was excepted to assist clinical decisions regarding surgery.It was a retrospective study. The 1249 consecutive patients with PTC were reviewed. Of these, 570 patients who met the criteria were selected: 285 with solitary papillary thyroid cancer and 285 with multifocal PTC. The risk factors and lymph node metastasis in multifocal PTC were investigated by univariate and multivariate analysis.Multifocal PTC showed a higher positive rate of capsular invasion, extrathyroidal extension, tumor size >10 mm, pathological T classification, N+ stage, local recurrence, and radioactive iodine ablation (RAI). Capsular invasion (hazard ratio [HR], 1.589; 95% confidence interval [CI],1.352-1.984), advanced pathological T classification (HR, 3.582; 95% CI, 2.184-5.870), and pathological N+ stage (HR, 1.872; 95% CI, 1.278-2.742) were related to increased risk of multifocality and there was a significant increased HR for central neck compartment involvement in male sex (HR, 2.694; 95% CI, 1.740-4.169), advanced pathological T classification (HR, 2.403; 95% CI, 1.479-3.907) and multifocality (HR, 1.988; 95% CI, 1.361-2.906).There is a significant association between capsular invasion, advanced pathological T classification, N+ stage, and multifocal PTC. Total thyroidectomy plus prophylactic bilateral central lymph node dissection should be recommended during surgery due to a stronger predilection for level VI lymph node metastasis in multifocal PTC.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29384841
OWN - NLM
STAT- MEDLINE
DCOM- 20180213
LR  - 20180213
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 5
DP  - 2018 Feb
TI  - Independent predictors and lymph node metastasis characteristics of multifocal
      papillary thyroid cancer.
PG  - e9619
LID - 10.1097/MD.0000000000009619 [doi]
AB  - The multifocal papillary thyroid cancer (PTC), with more aggressive and poorer
      prognosis, is not rare in papillary histotype. Few studies evaluated risk factors
      and lymph node metastasis in multifocal PTC. The aim of this present study
      focusing on risk factors and lymph node metastasis characteristics in multifocal 
      PTC was excepted to assist clinical decisions regarding surgery.It was a
      retrospective study. The 1249 consecutive patients with PTC were reviewed. Of
      these, 570 patients who met the criteria were selected: 285 with solitary
      papillary thyroid cancer and 285 with multifocal PTC. The risk factors and lymph 
      node metastasis in multifocal PTC were investigated by univariate and
      multivariate analysis.Multifocal PTC showed a higher positive rate of capsular
      invasion, extrathyroidal extension, tumor size >10 mm, pathological T
      classification, N+ stage, local recurrence, and radioactive iodine ablation
      (RAI). Capsular invasion (hazard ratio [HR], 1.589; 95% confidence interval
      [CI],1.352-1.984), advanced pathological T classification (HR, 3.582; 95% CI,
      2.184-5.870), and pathological N+ stage (HR, 1.872; 95% CI, 1.278-2.742) were
      related to increased risk of multifocality and there was a significant increased 
      HR for central neck compartment involvement in male sex (HR, 2.694; 95% CI,
      1.740-4.169), advanced pathological T classification (HR, 2.403; 95% CI,
      1.479-3.907) and multifocality (HR, 1.988; 95% CI, 1.361-2.906).There is a
      significant association between capsular invasion, advanced pathological T
      classification, N+ stage, and multifocal PTC. Total thyroidectomy plus
      prophylactic bilateral central lymph node dissection should be recommended during
      surgery due to a stronger predilection for level VI lymph node metastasis in
      multifocal PTC.
FAU - Genpeng, Li
AU  - Genpeng L
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
FAU - Jianyong, Lei
AU  - Jianyong L
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
FAU - Jiaying, You
AU  - Jiaying Y
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
FAU - Ke, Jiang
AU  - Ke J
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
FAU - Zhihui, Li
AU  - Zhihui L
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
FAU - Rixiang, Gong
AU  - Rixiang G
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
FAU - Lihan, Zhang
AU  - Lihan Z
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
FAU - Jingqiang, Zhu
AU  - Jingqiang Z
AD  - Thyroid and Parathyroid Surgery Center, West China Hospital.
AD  - West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - Thyroid cancer, papillary
SB  - AIM
SB  - IM
MH  - Adult
MH  - Carcinoma, Papillary/*diagnosis/epidemiology/pathology/*therapy
MH  - Female
MH  - Humans
MH  - Lymph Node Excision
MH  - Lymphatic Metastasis/*diagnosis/pathology
MH  - Male
MH  - Middle Aged
MH  - Neoplasms, Multiple Primary/*diagnosis/epidemiology/pathology/*therapy
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sex Factors
MH  - Thyroid Neoplasms/*diagnosis/epidemiology/pathology/*therapy
MH  - Thyroidectomy
MH  - Treatment Outcome
EDAT- 2018/02/01 06:00
MHDA- 2018/02/14 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/14 06:00 [medline]
AID - 10.1097/MD.0000000000009619 [doi]
AID - 00005792-201802020-00003 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Feb;97(5):e9619. doi: 10.1097/MD.0000000000009619.