Seyed Ziaeddin RASİHASHEMİ, Zahra SHİLAN, Samad FARASHİ BONAB, Ebrahim FARASHİ

Multifokal Papiller Tiroid Karsinomlu Hastalarda Total Tiroidektominin Sonuçları ve Patolojik Özellikleri

Amaç: Tiroid kanseri insidansı son yıllarda önemli ölçüde artmıştır. Multifokalite, papiller tiroid karsinomu (papillary thyroid carcinoma, PTC) için kötü bir prognostik faktör olarak kabul edilir. Multifokal PTC (MPTC)li hastalar, lenfatik ve distal metastazların yanı sıra lokal nüks açısından yüksek risk altındadır. Bu çalışmada MPTC özellikleri ve sonuçları incelendi. Gereç ve Yöntemler: Bu retrospektif çalışma, 300 PTC’li hasta üzerinde yapıldı. Hastalar multifokal grup ve unifokal grup olmak üzere sınıflandırıldı. PTC'nin patolojik özellikleri ve hastaların sonuçları analiz edildi ve karşılaştırıldı. Bulgular: Multifokal grupta 146 hasta (%48,7), unifokal grupta ise 154 hasta (%51,3) vardı. Multifokalite oluşumu kadınlarda erkeklerden daha yüksekti (Odds ratio, OR: 2,37, %95 güven aralığı, GA: 1,20-4,67; p=0,015). Multifokal gruptaki >1 cm olan tümör boyutu, unifokal gruptakinden daha büyüktü (sırasıyla 2,5 ve 2,2 cm; p=0,021). Ayrıca, multifokal gruptaki orta düzeyde nüks riskinin unifokal gruba göre daha yüksek olduğu saptandı (OR: 1,63, %95 GA: 1.01-2.60; p=0,044). Tedavi sonrası takipte, MPTC hastalarında daha yüksek lenf nodu metastazı vardı (OR: 2,89, %95 CI: 1,23-6,80; p=0,014). Ek olarak, tiroglobulin plazma seviyeleri (p=0.026) ve hastalık nüksü (OR: 2,41, %95 CI: 1,05-5,52; p=0,037), multifokal grupta unifokal gruba göre anlamlı olarak daha yüksek bulundu. Sonuç: MPTC'li hastalarda hastalık nüksü riski daha yüksekti ve multifokalitenin genel hastalık nüksü için bağımsız bir prognostik faktör olduğu sonucuna ulaşıldı.

Anahtar Kelimeler:

papiller tiroid karsinomu, , tiroidektomi, multifokalite, , nüks

Outcomes and Pathological Features of Total Thyroidectomy in Patients with Multifocal Papillary Thyroid Carcinoma

Aim: The incidence of thyroid cancer has increased dramatically in recent decades. Multifocality is considered a poor prognostic factor for papillary thyroid carcinoma (PTC). Patients with multifocal PTC (MPTC) are at high risk for local recurrence, as well as lymphatic and distal metastases. This study examined the features and outcomes of MPTC. Material and Methods: This retrospective study was conducted on 300 patients with PTC. Patients were classified into a multifocal group and a unifocal group. The pathological features of the PTC and the patients’ outcomes were analyzed and compared. Results: The multifocal group included 146 patients (48.7%), while the unifocal group included 154 patients (51.3%). The occurrence of multifocality was higher in females than in males (Odds ratio, OR: 2.37, 95% confidence interval, CI: 1.20-4.67, p=0.015). Tumor size of >1 cm in the multifocal group was larger than in the unifocal group (2.5 and 2.2 cm, respectively, p=0.021). Moreover, in multifocal group higher moderate risk of recurrence was detected than in the unifocal group (OR: 1.63, 95% CI: 1.01-2.60, p=0.044). At follow-up after treatment, MPTC patients had higher lymph node metastasis (OR: 2.89, 95% CI: 1.23-6.80, p=0.014). In addition, significantly higher thyroglobulin plasma levels (p=0.026) and disease recurrence (OR: 2.41, 95% CI: 1.05-5.52, p=0.037) were found in the multifocal group compared to the unifocal group. Conclusion: Patients with MPTC had a higher risk of disease recurrence, and multifocality was concluded to be an independent prognostic factor for overall disease recurrence.

Keywords:

papillary thyroid carcinoma, thyroidectomy, multifocality, recurrence,

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