Victoria Harries1, Laura Y Wang1, Marlena McGill1, Bin Xu2, R Michael Tuttle3, Richard J Wong1, Ashok R Shaha1, Jatin P Shah1, Ronald Ghossein2, Snehal G Patel1, Ian Ganly4. 1. Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Medicine, Endocrine Service, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ganlyi@mskcc.org.
Abstract
BACKGROUND: Multifocality in papillary thyroid carcinoma is common. The aim of this study is to determine whether patients with multifocal disease, treated with lobectomy alone, have an increased risk of contralateral lobe papillary thyroid carcinoma, regional recurrence, and poorer survival. METHODS: After institutional review board approval, papillary thyroid carcinoma patients managed from 1986 to 2015 with lobectomy alone were identified from an institutional database. Papillary thyroid carcinoma patients with pT3 to T4 classification, nodal disease, or distant metastases were excluded. After excluding 40 patients who underwent an immediate completion thyroidectomy, 849 were included in the analysis; 619 (72.9%) had unifocal disease and 230 (27.1%) had multifocal disease. Contralateral lobe papillary thyroid carcinoma-free probability, regional recurrence-free probability, disease-specific survival, and overall survival were calculated using the Kaplan-Meier method. RESULTS: With a median follow-up of 58 months, unifocal disease and multifocal disease patients had similar rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival (10-year contralateral lobe papillary thyroid carcinoma-free probability 98.6% vs 97.8%; regional recurrence-free probability 99.5% vs 99.4%; overall survival 91.6% vs 93.1%, respectively). There were no disease-related deaths. CONCLUSION: Select multifocal disease patients, managed with lobectomy alone, have rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival comparable to unifocal disease patients. Multifocal disease should not be an indication for completion thyroidectomy.
BACKGROUND: Multifocality in papillary thyroid carcinoma is common. The aim of this study is to determine whether patients with multifocal disease, treated with lobectomy alone, have an increased risk of contralateral lobe papillary thyroid carcinoma, regional recurrence, and poorer survival. METHODS: After institutional review board approval, papillary thyroid carcinomapatients managed from 1986 to 2015 with lobectomy alone were identified from an institutional database. Papillary thyroid carcinomapatients with pT3 to T4 classification, nodal disease, or distant metastases were excluded. After excluding 40 patients who underwent an immediate completion thyroidectomy, 849 were included in the analysis; 619 (72.9%) had unifocal disease and 230 (27.1%) had multifocal disease. Contralateral lobe papillary thyroid carcinoma-free probability, regional recurrence-free probability, disease-specific survival, and overall survival were calculated using the Kaplan-Meier method. RESULTS: With a median follow-up of 58 months, unifocal disease and multifocal diseasepatients had similar rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival (10-year contralateral lobe papillary thyroid carcinoma-free probability 98.6% vs 97.8%; regional recurrence-free probability 99.5% vs 99.4%; overall survival 91.6% vs 93.1%, respectively). There were no disease-related deaths. CONCLUSION: Select multifocal diseasepatients, managed with lobectomy alone, have rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival comparable to unifocal diseasepatients. Multifocal disease should not be an indication for completion thyroidectomy.
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