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Number of tumor foci predicts prognosis in papillary thyroid cancer.

Qu N, Zhang L, Ji QH, Zhu YX, Wang ZY, Shen Q, Wang Y, Li DS - BMC Cancer (2014)

Bottom Line: The Kaplan-Meier curves revealed that G3 had the shortest recurrence-free survival, and differences were significant among the 3 groups (p=0.001, Log Rank test).Furthermore, cancer-specific survival rates decreased significantly with increasing number of tumor foci (p=0.041).An increase in the number of tumors is associated with a tendency toward more aggressive features and predicts poor prognosis in PTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China. jiqinghai@shca.org.cn.

ABSTRACT

Background: Papillary thyroid cancer (PTC) often presents as multifocal. However, the association of multifocality with poor prognosis remains controversial. The aim of this retrospective study was to identify the characteristics of PTC with multiple foci and to evaluate the association between multifocality and prognosis.

Methods: We reviewed the medical records of 496 patients who underwent total thyroidectomy for PTC. Patients were classified as G1 (1 tumor focus), G2 (2 foci), and G3 (3 or more foci). We analyzed the clinicopathological features and clinical outcomes in each classification. A Cox regression model was used to assess the relationship between multifocality and recurrence or cancer mortality.

Results: The G1, G2 and G3 groups included 287, 141 and 68 patients, respectively. The mean age was 47.1±16.1 yr in G1, 41.1±18.4 yr in G2, and 35.5±15.9 yr in G3 and differed significantly among the 3 groups (p=0.001). The proportion of extrathyroidal extension, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) in the G1 to G3 groups increased with increasing number of tumor foci. The Kaplan-Meier curves revealed that G3 had the shortest recurrence-free survival, and differences were significant among the 3 groups (p=0.001, Log Rank test). Furthermore, cancer-specific survival rates decreased significantly with increasing number of tumor foci (p=0.041). Independent predictors of recurrence by multivariate Cox analysis included >3 tumor foci [HR 2.60, 95% confidence interval (CI) 1.53-4.39, p=0.001] and extrathyroidal extension (HR 1.95, CI 1.12-3.38, p=0.018).

Conclusion: An increase in the number of tumors is associated with a tendency toward more aggressive features and predicts poor prognosis in PTC.

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Kaplan-Meier curves for recurrence-free survival (RFS) in the G1, G2 and G3 groups. (Log Rank test, p = 0.001).
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Fig1: Kaplan-Meier curves for recurrence-free survival (RFS) in the G1, G2 and G3 groups. (Log Rank test, p = 0.001).

Mentions: The mean length of follow-up was 124.3 ± 67.8 months, with a range of 10 to 343 months. During the follow-up period, 57 patients (11.5%) experienced neck recurrence, including recurrence in the thyroid or operation bed (n = 13), lateral neck (n = 40), or both locations (n = 4). Distant recurrences occurred in 22 patients (4.4%), including 16 lung metastases, 5 bone metastases, and 1 brain metastasis. Four patients exhibited both neck recurrence and distant recurrence; therefore, the frequency of total recurrence was 15.1% (75/496), and the RFS rate was 84.3% at 10 yr, 70.8% at 15 yr, and 69.6% at 20 yr from the time of the initial operation. The Kaplan–Meier curve was used to investigate the differences in RFS rates among the 3 groups (Figure 1). Patients with 3 or more tumor foci exhibited the shortest RFS, followed by G1 and G2, and differences were significant among the 3 groups (p = 0.001, Log Rank test).Figure 1


Number of tumor foci predicts prognosis in papillary thyroid cancer.

Qu N, Zhang L, Ji QH, Zhu YX, Wang ZY, Shen Q, Wang Y, Li DS - BMC Cancer (2014)

Kaplan-Meier curves for recurrence-free survival (RFS) in the G1, G2 and G3 groups. (Log Rank test, p = 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289292&req=5

Fig1: Kaplan-Meier curves for recurrence-free survival (RFS) in the G1, G2 and G3 groups. (Log Rank test, p = 0.001).
Mentions: The mean length of follow-up was 124.3 ± 67.8 months, with a range of 10 to 343 months. During the follow-up period, 57 patients (11.5%) experienced neck recurrence, including recurrence in the thyroid or operation bed (n = 13), lateral neck (n = 40), or both locations (n = 4). Distant recurrences occurred in 22 patients (4.4%), including 16 lung metastases, 5 bone metastases, and 1 brain metastasis. Four patients exhibited both neck recurrence and distant recurrence; therefore, the frequency of total recurrence was 15.1% (75/496), and the RFS rate was 84.3% at 10 yr, 70.8% at 15 yr, and 69.6% at 20 yr from the time of the initial operation. The Kaplan–Meier curve was used to investigate the differences in RFS rates among the 3 groups (Figure 1). Patients with 3 or more tumor foci exhibited the shortest RFS, followed by G1 and G2, and differences were significant among the 3 groups (p = 0.001, Log Rank test).Figure 1

Bottom Line: The Kaplan-Meier curves revealed that G3 had the shortest recurrence-free survival, and differences were significant among the 3 groups (p=0.001, Log Rank test).Furthermore, cancer-specific survival rates decreased significantly with increasing number of tumor foci (p=0.041).An increase in the number of tumors is associated with a tendency toward more aggressive features and predicts poor prognosis in PTC.

View Article: PubMed Central - PubMed

Affiliation: Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China. jiqinghai@shca.org.cn.

ABSTRACT

Background: Papillary thyroid cancer (PTC) often presents as multifocal. However, the association of multifocality with poor prognosis remains controversial. The aim of this retrospective study was to identify the characteristics of PTC with multiple foci and to evaluate the association between multifocality and prognosis.

Methods: We reviewed the medical records of 496 patients who underwent total thyroidectomy for PTC. Patients were classified as G1 (1 tumor focus), G2 (2 foci), and G3 (3 or more foci). We analyzed the clinicopathological features and clinical outcomes in each classification. A Cox regression model was used to assess the relationship between multifocality and recurrence or cancer mortality.

Results: The G1, G2 and G3 groups included 287, 141 and 68 patients, respectively. The mean age was 47.1±16.1 yr in G1, 41.1±18.4 yr in G2, and 35.5±15.9 yr in G3 and differed significantly among the 3 groups (p=0.001). The proportion of extrathyroidal extension, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) in the G1 to G3 groups increased with increasing number of tumor foci. The Kaplan-Meier curves revealed that G3 had the shortest recurrence-free survival, and differences were significant among the 3 groups (p=0.001, Log Rank test). Furthermore, cancer-specific survival rates decreased significantly with increasing number of tumor foci (p=0.041). Independent predictors of recurrence by multivariate Cox analysis included >3 tumor foci [HR 2.60, 95% confidence interval (CI) 1.53-4.39, p=0.001] and extrathyroidal extension (HR 1.95, CI 1.12-3.38, p=0.018).

Conclusion: An increase in the number of tumors is associated with a tendency toward more aggressive features and predicts poor prognosis in PTC.

Show MeSH
Related in: MedlinePlus