Multifocal papillary thyroid microcarcinomas: is the total tumor diameter associated with the tumor behavior? A retrospective cohort study.
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OBJECTIVE: To evaluate whether the total tumor diameter (sum of the largest diameters of all foci) predicts tumor aggressiveness at initial presentation and treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma. METHODS: A retrospective analysis was conducted on 475 patients with differentiated thyroid carcinoma. Fifty-two patients with multifocal papillary thyroid microcarcinoma were included. The primary variable was total tumor diameter, and outcomes included initial tumor aggressiveness, evaluated according to the American Joint Committee on Cancer (AJCC; stages I or II), risk of recurrence according to the American Thyroid Association (low or not low), and response to therapy at 1 year (excellent or not). RESULTS: AJCC stage II disease was significantly associated with age ≥55 years, lymph node dissection, angiolymphatic invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, non-low risk of recurrence, first stimulated thyroglobulin, and response to therapy at 1-year. Non-low risk of recurrence were associated with Bethesda V/VI cytology, lymph node dissection, angiolymphatic and tumor capsule invasion, extrathyroidal extension, lymph node metastasis, number of metastatic lymph nodes, first stimulated thyroglobulin, and radioiodine dose. Non-excellent response at 1-year follow-up were associated with preoperative thyroid-stimulating hormone levels, lymph node metastasis, number of metastatic lymph nodes, and first stimulated thyroglobulin. Multivariate analysis revealed that only the number of metastatic lymph nodes independently predicted AJCC stage. CONCLUSION: Total tumor diameter was not associated with initial tumor aggressiveness or treatment response at 1-year follow-up in patients with multifocal papillary thyroid microcarcinoma. BACKGROUND: ■ In multifocal papillary thyroid microcarcinomas. BACKGROUND: ■ The total tumor diameter was not associated with aggressiveness or initial evolution. BACKGROUND: ■ Other factors are associated with disease outcomes. BACKGROUND: ■ The number of metastatic lymph nodes is an independent predictor of American Joint Committee on Cancer stage. BACKGROUND: This study demonstrated that in multifocal papillary thyroid microcarcinomas, the sum of the largest diameters of all tumor foci was not associated with tumor aggressiveness or response to therapy at 1-year follow-up. Conversely, the total number of metastatic lymph nodes was an independent predictor of American Joint Committee on Cancer staging.