COMPARING RECURRENCE AND MORTALITY FOR MULTICENTRIC AND SOLITARY PAPILLARY THYROID CARCINOMA
M Lapkus, J Reilly, J Pastewski, F Sun, H Elassar, E Faridmoayer, D Studzinski, P Czako, S Nagar
Beaumont Hospital, Royal Oak
Multicentric papillary thyroid carcinoma (PTC) has been reported in the literature at a rate from 15% to 30%. Recurrence rates and mortality rates of multicentric PTC have not been well described. Further investigation can help guide treatment and prognosis as the incidence of thyroid carcinoma has been increasing.
Patients from a single institution who underwent thyroid surgery between January 2007 and December 2011 and had confirmed PTC on pathology were retrospectively reviewed. Multicentricity was defined as more than one tumor focus in the specimen. Demographics, tumor characteristics, recurrence rates, and all-cause mortality were studied.
A total of 605 patients were reviewed, and 536 (88.6%) were identified to have PTC. At a median follow up of 8.5 years, recurrence rate for PTC patients was 5.2% and the all-cause mortality rate was 2.5%. Of PTC patients, 212 (39.6%) were categorized as multicentric. Multicentric PTC was found to have a recurrence rate of 5.4% compared to 4.7% for solitary PTC (P = 0.837). All-cause mortality for multicentric PTC was 0% compared to 5.2% for solitary PTC (P = 0.002). Patient demographics were comparable between groups.
Multicentric PTC has been seen at higher rates than average. While we did not identify a difference in recurrence rates, we found that solitary PTC had increased all-cause mortality. The recommended surgical treatment for multicentric PTC is often total thyroidectomy followed by radioactive iodine ablation. This can lead to significant patient morbidity, and it is possible this radical treatment strategy could be reconsidered without a change in patient outcomes.
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