| PurposeMultifocal features are common in papillary thyroid carcinoma(PTC),but their impact on the clinical manifestations and prognosis of PTC is still controversial,and there is no consensus on the specific surgical scope for multifocal PTC.The aim of this study is to analyze and compare the clinical and pathological characteristics of multifocal PTC,as well as the relationship between multifocal characteristics and tumor invasiveness,in order to provide a theoretical basis for determining the surgical scope in clinical practice.MethodsWe collected clinical and pathological data from 533 patients with PTC in our general surgery department from January 2019 to December 2022,including 392 females and 141 males,with a median age of 43(33-53)years.Among them,there were 377 cases of single focal PTC and 156 cases of multifocal PTC.Firstly,the patients were divided into a single lesion group and a multi lesion group.The differences in gender,age,presence of Hashimoto’s thyroiditis,maximum tumor diameter,membrane invasion,vascular invasion,central lymph node metastasis,cervical lymph node metastasis,and extraglandular invasion between the two groups were compared,and the clinical and pathological characteristics of multifocal PTC were analyzed.Then group multifocal PTC according to the number of cancer lesions and analyze the relationship between the number of cancer lesions and their invasiveness.Divide multifocal PTC into unilateral multifocal group and bilateral multifocal group,and compare them with single focal PTC to analyze the similarities and differences in clinical and pathological characteristics of the three groups.Use univariate and multivariate logistic regression analysis to analyze whether multifocal PTC is an independent risk factor for central lymph node metastasis,cervical lymph node metastasis,and extraglandular invasion in PTC.Finally,the risk factors for central lymph node metastasis,cervical lymph node metastasis,and extraglandular invasion in highly invasive bilateral multifocal PTC were analyzed.ResultThe age of patients with multifocal PTC was significantly higher than that of patients with single-focal PTC[48(36-55.8)years vs 41(32-52)years,P<0.001].Compared with patients with monofocal PTC,patients with multifocal PTC are older[48(36-55.8)years old compared to 41(32-52)years old,P<0.001]and have a larger tumor diameter[9(5.6-13.8)mm compared to 7(5-12)mm,P<0.001],and are more prone to tumor capsule invasion and extraglandular invasion,as well as lymph node metastasis in the central and cervical regions(P<0.05).There was no significant difference in clinical and pathological characteristics between multifocal PTC with different numbers of cancer foci(P>0.05).The presence or absence of bilateral cancer lesions has a significant impact on the clinical and pathological characteristics of patients with multifocal PTC.Bilateral multifocal PTC is significantly more invasive than single focal PTC,and there is no significant difference in clinical and pathological characteristics between unilateral multifocal PTC and single focal PTC(all P>0.05).The results of multivariate analysis showed that bilateral multifocal rather than unilateral multifocal was an independent related factor for central lymph node metastasis(OR=2.084,95%CI:1.083-4.009,P=0.028),cervical lymph node metastasis(OR=4.318,95%CI:1.99-9.372,P<0.001),and extraglandular invasion(OR=2.906,95%CI:1.325-6.3 72,P=0.008)in PTC.Finally,this study also found that accompanying vascular invasion is an independent risk factor for bilateral multifocal PTC with central lymph node metastasis(OR=17.981,95%CI:5.823-55.521,P<0.001)and cervical lymph node metastasis(OR=4.519,95%CI:1.099-18.59,P=0.037).And age>55 years old(OR=4.881,95%CI:1.447-16.466,P=0.011)and accompanying central lymph node metastasis(OR=5.387,95%CI:1.254-23.146,P=0.024)are independent risk factors for extraglandular invasion.Conclusion1.There is no statistically significant difference in the clinical and pathological characteristics between unilateral multifocal PTC and single focal PTC.It is recommended not to consider unilateral multifocal PTC as a high-risk factor,and to adopt the same surgical range as single focal PTC for unilateral multifocal PTC.2.Bilateral multifocal PTC is an independent risk factor for central lymph node metastasis,cervical lymph node metastasis,and extraglandular invasion.It is recommended to perform total thyroidectomy and preventive central lymph node dissection for bilateral multifocal PTC in accordance with current domestic guidelines for the diagnosis and treatment of thyroid cancer.Especially for patients with vascular invasion,preventive central lymph node dissection should be performed. |
