Clinicopathological Features And Risk Factors Of Multifocal Papillary Thyroid Carcinoma

Objective: To compare the clinicopathological differences between multifocal papillary thyroid carcinoma(mptc)and single focal papillary thyroid carcinoma(sfptc),To explore the high risk factors of multiple lesions in patients with thyroid papillary carcinoma,analyze the influence of various clinical pathological characteristics on multifocal occurrence,construct a prediction model of multifocal thyroid papillary carcinoma,and verify its prediction efficiency,so as to provide an effective reference for the establishment of clinical surgical diagnosis and treatment plan.Methods: The case data of 2804 patients who underwent thyroid surgery and were diagnosed with thyroid papillary carcinoma according to the routine pathological results after surgery in Shaoxing People’s Hospital from January 2016 to December 2021 were retrospectively analyzed,including 835 cases in multi-focal group and 1969 cases in singlefocal group.By comparing the differences in age,gender,body mass index(BMI),reason for presentation,family history,PTC operation history,focal calcification,combined nodular goiter,combined Hashimoto’s thyroiditis,combined subacute granulomatous thyroiditis,combined adenomatoid goiter,largest lesion diameter,capsule infiltration of thyroid cancer,and cervical lymph node metastasis between multifocal and monofocal PTC patients,The unique clinical pathological characteristics of MPTC were analyzed and summarized,and the independent risk factors for the occurrence of MPTC were explored using single-factor and multi-factor Logistic regression analysis,according to which a risk prediction model was constructed.HosmorLemeshow test was used to evaluate the fit of the model,and ROC was used to test the prediction efficiency of the risk prediction model.Results:There were no significant differences in age,gender,reason for presentation,family history of PTC,PTC operation history,and the combination of subacute granulomatous inflammation and adenomatous goiter between the multifocal group and the single-focal group.However,there were significant differences in body mass index,calcification of lesions,combination of nodular goiter,combination of Hashimoto’s thyroiditis,maximum diameter of lesions,capsule infiltration and cervical lymph node metastasis(P < 0.05).Six factors,including body mass index,calcification of lesions,combined Hashimoto’s thyroiditis,the largest diameter of the lesion,capsule infiltration and cervical lymph node metastasis,are all independent factors for multifocal PTC patients,and all of them have certain promoting effects on multifocal occurrence.According to the statistical results of SPSS,for every 1kg/m2 increase in BMI of PTC patients,the risk of multiple intraglandular lesions increased by 0.04 times(P< 0.05).When the lesions of PTC patients were calcified,the risk of multiple lesions in the glands was 0.4 times higher than that in the patients without lesion calcification(P < 0.05).When patients with PTC combined with Hashimoto’s thyroiditis,the risk of multiple lesions was increased by 0.42 times as compared with that in patients without combined Hashimoto’s thyroiditis(P < 0.05).When the lesions of PTC patients had capsule infiltration,the risk of multiple lesions in the glands was 0.28 times higher than that in the patients without capsule infiltration(P < 0.05).The risk of multiple lesions in PTC patients with cervical lymph node metastasis was 0.8 times higher than that in patients without cervical lymph node metastasis(P< 0.05).Conclusion: The Logistic regression model of high risk factors of MPTC has good prediction efficiency.Clinically,we should focus on the patients with thyroid papillary carcinoma who have high body mass index,calcified lesions,combined Hashimoto’s thyroiditis,the largest diameter of the lesion less than 1cm,capsule infiltration and cervical lymph node metastasis,and they are prone to multiple lesions.