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. 2023 Nov 17;108(12):3135-3144.
doi: 10.1210/clinem/dgad369.

Is Multifocality a Predictor of Poor Outcome in Childhood and Adolescent Papillary Thyroid Carcinoma?

Daniel W Scholfield  1 , Joseph Lopez  2 , Alana Eagan  1 , Zoltan Antal  3 , R Michael Tuttle  4 , Ronald Ghossein  5 , Michael LaQuaglia  6 , Ashok R Shaha  1 , Jatin P Shah  1 , Richard J Wong  1 , Snehal G Patel  1 , Ian Ganly  1
Affiliations

Is Multifocality a Predictor of Poor Outcome in Childhood and Adolescent Papillary Thyroid Carcinoma?

Daniel W Scholfield et al. J Clin Endocrinol Metab. .

Abstract

Context: Total thyroidectomy in pediatric papillary thyroid carcinoma (PTC) is recommended in national guidelines because of the high incidence of multifocal disease (MFD).

Objective: To determine the incidence of MFD in childhood and adolescent vs adult PTC and whether MFD is a predictor for poorer outcomes in childhood and adolescent PTC.

Methods: We conducted an institutional review board-approved review of patients with PTC undergoing surgery (1986-2021) at Memorial Sloan Kettering Cancer Center. Clinical and pathological characteristics in patients with unifocal disease (UFD) and MFD were compared using Pearson's χ2 test. Survival outcomes were analyzed using the Kaplan-Meier method and log-rank test. Multivariate analysis assessed the impact of MFD on outcome.

Results: MFD was less common in childhood and adolescent patients with PTC (45%; 127/283) than in adults (54%; 3023/5564; P = .002). Childhood and adolescent patients with UFD and MFD had similar tumor stage and PTC subtype at presentation, with no significant difference in histopathologic features. Median follow-up was 68 months. There was no significant difference in 5-year recurrence-free probability and overall survival was 100% in both groups. There was no significant difference in 5-year contralateral lobe PTC-free probability between patients with UFD and MFD treated with lobectomy. Multivariate analysis showed MFD was not a predictor for recurrence.

Conclusion: MFD was less common in childhood and adolescent patients with PTC than adults and was not a predictor of poor outcome on multivariate analysis, with excellent long-term outcomes in all patients with PTC. MFD does not appear to warrant completion thyroidectomy in childhood and adolescent patients selected for lobectomy.

Keywords: multifocality; papillary thyroid carcinoma; pediatric thyroid carcinoma.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier of 10-year contralateral lobe PTC-free probability by focality.
Figure 2.
Figure 2.
Kaplan-Meier plot of 10-year recurrence-free survival stratified by focality.
Figure 3.
Figure 3.
Kaplan-Meier plot of 10-year disease-specific survival stratified by focality.
Figure 4.
Figure 4.
Kaplan-Meier plot of 10-year overall survival stratified by focality.
See this image and copyright information in PMC

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