The following is a summary of “Is Multifocality a Predictor of Poor Outcome in Childhood and Adolescent Papillary Thyroid Carcinoma?,” published in the December 2023 issue of Endocrinology by Scholfield, et al.
National guidelines advocate for total thyroidectomy in pediatric papillary thyroid carcinoma (PTC) due to its frequent presentation with multifocal disease (MFD). For a study, researchers sought to delineate the incidence of MFD in childhood and adolescent PTC compared to adult PTC and discern if MFD serves as an indicator for adverse outcomes in pediatric and adolescent PTC cases.
An exhaustive review of patients diagnosed with PTC who underwent surgery between 1986 and 2021 at Memorial Sloan Kettering Cancer Center was conducted following institutional review board approval. Comparative analyses of clinical and pathological features between unifocal disease (UFD) and MFD groups utilized Pearson’s χ2 test. Survival metrics were evaluated using Kaplan-Meier techniques, with the log-rank test employed for comparisons. Furthermore, a multivariate analysis was carried out to gauge the influence of MFD on outcomes.
In childhood and adolescent PTC patients, the prevalence of MFD was notably lower at 45% (127 out of 283) in contrast to adults, where it stood at 54% (3,023 out of 5,564), a difference deemed statistically significant with a P-value of .002. Notably, childhood and adolescent patients with both UFD and MFD showcased analogous tumor stages and PTC subtypes upon presentation, with no discernible disparities in histopathological attributes. The median follow-up duration spanned 68 months. Both UFD and MFD groups manifested identical 5-year recurrence-free probabilities and a 100% overall survival rate. Moreover, when treated with lobectomy, the 5-year contralateral lobe PTC-free probability between the two groups didn’t exhibit any significant differences. The multivariate analysis further indicated that MFD was not indicative of recurrence.
Contrary to prevailing assumptions, MFD manifests less frequently in childhood and adolescent PTC cases than in adults. Importantly, it does not emerge as a harbinger of unfavorable outcomes based on multivariate analysis. Given these insights, MFD doesn’t necessitate completion of thyroidectomy for childhood and adolescent patients when lobectomy is the chosen surgical approach, underlining the overall favorable long-term outcomes observed across all PTC patients.
Source: academic.oup.com/jcem/article-abstract/108/12/3135/7205636?redirectedFrom=fulltext
