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Meta-Analysis
. 2021 Oct 1;147(10):847-854.
doi: 10.1001/jamaoto.2021.1976.

Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis

Hyeonkyeong Kim  1 , Hyungju Kwon  1 , Byung-In Moon  1
Affiliations
Meta-Analysis

Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma: A Systematic Review and Meta-analysis

Hyeonkyeong Kim et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Multifocality is common in papillary thyroid carcinoma (PTC), but it is unclear whether multifocal tumors are associated with tumor recurrence or cancer-specific survival.

Objective: To compare tumor recurrence rates in patients with multifocal vs unifocal PTCs.

Data sources: We searched PubMed, SCOPUS, Web of Science Core Collection, and Cochrane Database of Systematic Reviews for pertinent studies published in English from inception to June 30, 2020.

Study selection: The search strategy yielded 26 studies that compared tumor recurrence in patients with multifocal vs unifocal PTC.

Data extraction and synthesis: Data was extracted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Characteristics of study populations and hazard ratio (HR) of multifocality were independently extracted by 2 investigators.

Main outcomes and measures: The primary outcome was tumor recurrence and the secondary outcome was cancer-specific survival. Subgroup analysis of the primary outcome was based on primary tumor size, number of tumor foci, and patient age.

Results: Among 26 studies with a total of 33 976 patients, recurrence rates were significantly higher in patients with multifocal PTC than in those with unifocal PTC (pooled HR, 1.81; 95% CI, 1.52-2.14). Cancer-specific survival was comparable between the groups (HR, 1.19; 95% CI, 0.85-1.68). In subgroup analyses, the HRs of multifocality for recurrence were associated with primary tumor size (HRs for PTC ≤1 cm and >1 cm were 1.81 and 1.90, respectively), number of tumor foci (HRs for 2 foci and ≥3 foci were 1.45 and 1.95, respectively), and patient age (HRs for pediatric and adult patients were 3.19 and 1.89, respectively).

Conclusions and relevance: This systematic review with meta-analysis found that multifocality was significantly associated with an increased risk of recurrence in patients with PTC, while cancer-specific survival showed no difference. Differences in tumor size, number of tumor foci, and patient age should be considered when interpreting the multifocality and the risk of recurrence.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Forest Plot of the Included Studies Analyzing Recurrence Rates Among Patients With Multifocal vs Unifocal Disease
Abbreviation: NA, not applicable.
Figure 2.
Figure 2.. Forest Plot of Subgroup Analysis (Tumor Size, Number of Foci, and Patient Age Group) of the Included Studies of Cancer-Specific Survival Rates Among Patients With Multifocal vs Unifocal Disease
NA indicates not applicable; PTMC, papillary thyroid microcarcinoma.
Figure 3.
Figure 3.. Forest Plot of the Included Studies Analyzing Cancer-Specific Survival Rates Among Patients With Multifocal vs Unifocal Disease
Figure 4.
Figure 4.. Funnel Plot Analysis of Recurrence Rates of Included Studies
Circles indicate the studies; the dotted line, no intervention effect; and the dashed line, pooled estimates.
See this image and copyright information in PMC

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