| Objective: In recently years, the incidence of thyroid papillary carcinoma(papillary thyroid carcinoma, PTC) is increasing rapidly. Multiple focuses is one of theclinical features of PTC, it related to lymph node metastasis, treatment and recurrence,and it is an important factor for the prognosis judgment. This study explores theconstituent ratio, clinical characteristics and treatment of multifocal thyroid papillarycarcinoma (multifocal papillary thyroid carcinoma, MPTC), in order to provide moreinformation and guidance for clinical diagnosis and treatment of MPTC.Methods:1616cases of PTC were retrospectively analyzed from January2002toDecember2011of the first affiliate hospital of Dalian medical university, whichoperated at the first time and confirmed by pathology. They were divided intomultifocal group and single focal group according to the number of lesions, the changeof constituent ratio of MPTC in PTC was analyzed; the differences of the two groupswere analyzed in age, sex, clinical manifestation, color Doppler ultrasound examinationbefore operation, accompany with benign lesions, whether neck lymph node metastasisor extrathyroidal invasion through comparing the general data, auxiliary examinationsand pathological results. The differences in neck lymph node metastasis andextrathyroidal invasion of the groups with two sides multifocal and one sides multifocal,pure microcarcinoma and none pure microcarcinoma, two and more than two focuseswere analyzed according to the pathology results of patients with multifocal. Therelationship of lymph node metastasis and recurrence were analyzed throughfollowing-up the relapse and survival condition of multifocal cases.Results: In the1616cases of PTC,377cases are multifocal, with136male and241female;1239are single focal, with334male and905female. The constituent ratio ofMPTC in PTC is increasing from8.33%in2002to30.38%in2011gradually (χ~2=31.347,P=0.000). Male case has the higher rate (36.07%) in MPTC of multiplefocal than the rate (26.96%) in single focal (χ~2=11.649, P χ~2=0.001). The ages of highincidence of the two groups are41-50. Compared to the single focal group, multiplefocal group has the higher rate of neck lymph node metastasis [45.09%(170/377) vs25.02%(310/1239); χ~2=55.776,P=0.000], extrathyroidal invasion [20.95%(79/377) vs9.04%(112/1239); χ~2=39.375,P=0.000], neck lymph node enlargemen[46.68%(176/377) vs38.58%(478/1239); χ~2=7.881,P=0.005], and sand-likemicro-calcification [68.98%(260/377) vs61.90%(767/1239); χ~2=6.221,P=0.014]examined by color Doppler ultrasound, they are reach statistical significance. But theyare don’t reach statistical significance about accompany with benign lesions [62.33%(235/377) vs63.68%(789/1239); χ~2=0.226,P=0.069].Compared with single side multifocal in the cases of MPTC, two sides multifocalhas higher rates of neck lymph node metastasis[48.03%(122/254) vs39.02%(48/123);χ~2=16.976,P=0.000], but no significant difference about the rates of extrathyroidalinvasion [21.26%(54/254) vs20.33%(25/123); χ~2=0.444,P=0.893]; none puremicrocarcinoma has higher rate of neck lymph node metastasis than puremicrocarcinoma [57.14%(132/231) vs26.03%(38/146); χ~2=34.982,P=0.000], nosignificant difference about extrathyroidal invasion [20.78%(48/231) vs21.23%(31/146); χ~2=0.011,P=0.507]; more than two focuses has higher rate of necklymph node metastasis than two focuses [59.29%(83/140) vs26.71%(87/237);χ~2=18.119,P=0.000], and also don’t reach significant difference about extrathyroidalinvasion [20.71%(29/140) vs21.10%(50/237); χ~2=0.008,P=0.520]. There are325casesin the377of multifocal (86.20%) were followed-up, and the followed-up time is4-124months;21cases died in4-70months after non-radical operation of suffocation anddistant metastasis to failure;53cases were recurrent (16.31%) in7-39months afteroperation, did operation again, and still alive now. The rate of recurrence with lymphnode metastasis (24.05%) is higher than that without lymph node metastasis (8.98%),and reach statistically significant (χ~2=13.570,P=0.000). The total1,3,5and10yearssurvival rates of cases with multifocal are98.94%,97.08%,94.69%,94.43%.Conclusion: The constituent ratio of MPTC in PTC is increasing from2002to2011gradually. The male case has higher proportion in PTC multifocal group than thatin single focal group. Multifocal group has high proportion of lymph node metastasisand extrathyroidal invasion than single focal group. Compared to the MPTC cases oftwo sides multifocal, none pure microcarcinoma and more than two focuses, the cases of single side multifocal, pure microcarcinoma and two focuses have higher rates ofneck lymph node metastasis; the recurrence rate is correlated with the rate of lymphnode metastasis conformed by postoperative pathology. |
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