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The Prognostic Value of Tumor Multifocality in Clinical Outcomes of Papillary Thyroid Cancer
F. Wang, X. Yu, X. Shen, G. Zhu, Y. Huang, R. Liu, D. Viola, R. Elisei, E. Puxeddu, L. Fugazzola, C. Colombo, B. Jarzab, A. Czarniecka, AK. Lam, C. Mian, F. Vianello, L. Yip, G. Riesco-Eizaguirre, P. Santisteban, CJ. O'Neill, MS. Sywak, R....
Language English Country United States
Document type Comparative Study, Journal Article, Multicenter Study
Grant support
NV16-32665A
MZ0
CEP Register
Digital library NLK
Full text - Article
NLK
Free Medical Journals
from 1997 to 1 year ago
ProQuest Central
from 2017-01-01 to 2020-12-31
Health & Medicine (ProQuest)
from 2017-01-01 to 2020-12-31
PubMed
28582521
DOI
10.1210/jc.2017-00277
Knihovny.cz E-resources
- MeSH
- Adult MeSH
- Neoplasm Invasiveness pathology MeSH
- Kaplan-Meier Estimate MeSH
- Carcinoma mortality pathology surgery MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Recurrence, Local mortality pathology MeSH
- Lymphatic Metastasis MeSH
- Lymph Nodes pathology MeSH
- Survival Rate MeSH
- Multivariate Analysis MeSH
- Thyroid Neoplasms mortality pathology surgery MeSH
- Carcinoma, Papillary mortality pathology surgery MeSH
- Disease-Free Survival MeSH
- Prognosis MeSH
- SEER Program MeSH
- Proportional Hazards Models MeSH
- Neoplasm Staging MeSH
- Thyroidectomy methods mortality MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Comparative Study MeSH
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.
Department of Endocrinology and Metabolism Shandong Provincial Hospital Jinan 250021 China
Department of Internal Medicine University of Perugia 06100 Perugia Italy
Department of Medicine Endocrinology Unit University of Padua Padua 35128 Italy
Department of Molecular Endocrinology Institute of Endocrinology Prague 11694 Czech Republic
Endocrine Surgical Unit The University of Sydney Sydney 2052 Australia
Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology 44 101 Gliwice Poland
Prenatal Diagnosis Center The Affiliated Hospital of Qingdao University Qingdao 266003 China
Veneto Institute of Oncology Instituto di Ricovero e Cura a Carattere Scientifico Padua 35128 Italy
References provided by Crossref.org
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- $a The Prognostic Value of Tumor Multifocality in Clinical Outcomes of Papillary Thyroid Cancer / $c F. Wang, X. Yu, X. Shen, G. Zhu, Y. Huang, R. Liu, D. Viola, R. Elisei, E. Puxeddu, L. Fugazzola, C. Colombo, B. Jarzab, A. Czarniecka, AK. Lam, C. Mian, F. Vianello, L. Yip, G. Riesco-Eizaguirre, P. Santisteban, CJ. O'Neill, MS. Sywak, R. Clifton-Bligh, B. Bendlova, V. Sýkorová, Y. Wang, S. Liu, J. Zhao, S. Zhao, M. Xing,
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- $a 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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