Objective: To analyze the clinicopathologic implications of multifocal thyroid papillary carcinoma on poor prognostic outcomes. Methods: The clinical data of 1 681 patients suffering thyroid papillary carcinoma (PTC) was collected between June 2014 and June 2018 at the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, including 1 299 female cases and 382 male cases, with a mean age of (44.4±11.5) years, ranging from 11 to 76 years. The male-to-female ratio was 1∶3.4. The relationship between multifocality and poor prognostic indicators was further retrospectively analyzed. Results: Patients with multifocal papillary thyroid carcinoma were older [(46.4±11.0) years vs (43.5±11.5) years, P<0.001] and had larger tumor diameter [0.8(0.5, 0.8) cm vs 0.7(0.5, 0.7) cm, P<0.001]. The tumors were much easier to have infiltrative tumor margin, extrathyroidal extension and lymph node metastasis with multifocality (all P<0.05). The propensity score matching method was further used to match the confounding factors. Bilateral multifocal thyroid cancer was an independent risk factor for extrathyroidal extension (OR=1.983, 95%CI: 1.379-2.852, P<0.001), central lymph node metastasis (OR=2.393, 95%CI: 1.797-3.187, P<0.001) and lateral lymph node metastasis(OR=3.327, 95%CI: 2.253-4.912, P<0.001). However, unilateral multifocal thyroid cancerhad no effect on the unfavorable prognostic indicators. Conclusions: Central compartment neck dissection is not recommended for unilateral multifocal thyroid cancer. However, we recommend central lymph node dissection for bilateral multifocality in PTC patients. If necessary, lateral compartment neck dissection is also supposed to be considered when lateral lymph node metastasis exists.
目的： 分析多灶性甲状腺乳头状癌对临床预后的影响。 方法： 收集郑州大学第一附属医院甲状腺外科2014年6月至2018年6月1 681例甲状腺乳头状癌患者临床资料，女1 299例，男382例，男女比例为1∶3.4。年龄11~76（44.4±11.5）岁。回顾性分析多灶性与癌灶侵袭性生长方式的关系。 结果： 多灶性甲状腺乳头状癌患者年龄较大[（46.4±11.0）岁比（43.5±11.5）岁，P<0.001]，肿瘤直径较大[0.8（0.5，0.8）cm比0.7（0.5，0.7）cm，P<0.001]，更易出现癌灶突破包膜癌灶腺外浸润性生长，中央区和侧区淋巴结转移（均P<0.05）。倾向评分匹配法匹配混杂因素后进一步分析显示，双侧多灶性甲状腺癌是癌灶腺外浸润性生长（OR=1.983，95%CI：1.379~2.852，P<0.001），中央区（OR=2.393，95%CI：1.797~3.187，P<0.001）和侧区淋巴结转移（OR=3.327，95%CI：2.253~4.912，P<0.001）的独立相关因素，而单侧多灶性甲状腺癌与癌灶侵袭性生长方式无明显相关性。 结论： 对于单侧多灶性甲状腺乳头状癌，不推荐进行预防性中央区淋巴结清扫术。而对双侧多灶性甲状腺乳头状癌患者应进行预防性中央区淋巴结清扫术，若出现可疑性侧区淋巴结转移，需采取更积极的手术方式。.
Keywords: Multifocal; Neoplasm invasiveness; Propensity score; Thyroid neoplasms.