Multifocality and Hashimoto’s thyroiditis as independent predictors of structural recurrence in a cohort of low risk intrathyroidal papillary thyroid cancer.

e17577 Background: Increasing incidence of thyroid malignancies is almost totally attributable to papillary thyroid cancer (PTC). Although all disease stages are involved, PTCs confined to the thyroid were those with the higher trend. The absence of dedicated randomized controlled trials makes challenging the management of these low risk PTC at different steps of the therapeutic process (extent of surgery, prophylactic central node dissection, and radio-iodine treatment). Thus, it is mandatory to set a prognostic system suitable for this clinical setting. We analyzed prognostic factors of structural recurrence in a large cohort of consecutive low-risk intra-thyroidal PTC. Methods: Multicenter retrospective study including pT1/2 PTC without any evidence of extra-thyroidal disease. The following parameters were considered: gender, age at diagnosis, histology, tumour size, multifocality, pathologically-proven Hashimoto’s thyroiditis (HT), and radiometabolic treatment (RAI). The parameters significantly associated with structural recurrence at the univariate analysis ( p < 0.05) were included in the multivariate analysis. Results: We included 284 patients (mean follow-up 6.3 yrs). At univariate analysis, parameters achieving significance were: age at diagnosis ≥ 45 yrs (p = 0.001, OR 0.04, 95% CI 0-0.72), microcarcinoma (p < 0.001, OR 0.02, 95% CI 0-0.39), multifocality (p < 0.001, OR 4.3, 95% CI 1.88-9.84), HT (p = 0.018, OR 0.33, 95% CI 0.13-0.86), and RAI (p = 0.002, OR 19.43, 95% CI 1.16-323.3). At multivariate analysis, only multifocality (p = 0.042, OR 2.52, 95% CI 1.03-6.16) and HT (p = 0.036, OR 0.34, 95% CI 0.12-0.93) revealed as independent prognosticators. Conclusions: Our data show that multifocality and HT should be considered as the main parameters for the decision-making of low risk PTC. Further studies are required. Note: We acknowledge Umberto Veronesi Foundation for granting Vincenzo Marotta with Post-doctoral Fellowship year-2017 Award.

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Hashimoto’s thyroiditis predicts outcome in intrathyroidal papillary thyroid cancer

Endocrine Related Cancer ◽

10.1530/erc-17-0085 ◽

2017 ◽

Vol 24 (9) ◽

pp. 485-493 ◽

Cited By ~ 10

Author(s):

Vincenzo Marotta ◽

Concetta Sciammarella ◽

Maria Grazia Chiofalo ◽

Claudio Gambardella ◽

Claudio Bellevicine ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Hashimoto’S Thyroiditis ◽

Clinical Remission ◽

Tumour Size ◽

Study Endpoint ◽

Hashimoto's Thyroiditis ◽

Primary Study ◽

Prognostic Impact ◽

Papillary Thyroid

Hashimoto’s thyroiditis (HT) seems to have favourable prognostic impact on papillary thyroid cancer (PTC), but data were obtained analysing all disease stages. Given that HT-related microenvironment involves solely the thyroid, we aimed to assess the relationship between HT, as detected through pathological assessment, and outcome in intrathyroidal PTC. This was a multicentre, retrospective, observational study including 301 PTC with no evidence of extrathyroidal disease. Primary study endpoint was the rate of clinical remission. Auxiliary endpoint was recurrence-free survival (RFS). HT was detected in 42.5% of the cohort and was associated to female gender, smaller tumour size, lower rate of aggressive PTC variants and less frequent post-surgery radio-iodine administration. HT showed relationship with significantly higher rate of clinical remission (P < 0.001, OR 4, 95% CI 1.78–8.94). PTCs with concomitant HT had significantly longer RFS, as compared with non-HT tumours (P = 0.004). After adjustment for other parameters affecting disease outcome at univariate analysis (age at diagnosis, histology, tumour size and multifocality), prognostic effect of HT remained significant (P = 0.006, OR 3.28, 95% CI 1.39–7.72). To verify whether HT could optimise the identification of PTCs with unfavourable outcome, we assessed the accuracy of ‘non-HT status’ as negative prognostic marker, demonstrating poor capability of identifying patients not maintaining clinical remission until final follow-up (probability of no clinical remission in PTCs without HT: 21.05%, 95% CI 15.20–27.93). In conclusion, our data show that HT represents an independent prognostic parameter in intrathyroidal PTC, but cannot improve prognostic specificity.

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