Virginia Cappagli, Antonio Matrone, Valeria Bottici, Alessandro Prete, Teresa Ramone, Cristina Romei, Raffaele Ciampi, Clara Ugolini, Liborio Torregrossa, Paolo Piaggi, Rossella Elisei
Endocrine Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy.
Pathology Unit 3, Department of Surgical, Medical and Molecular Pathology, University Hospital of Pisa, Pisa, Italy.
Eur Thyroid J. 2025 Sep 5;14(5). doi: 10.1530/ETJ-25-0074. Print 2025 Oct 1.
At present, total thyroidectomy and central neck dissection are the surgical approaches recommended for the initial treatment of medullary thyroid cancer (MTC) independently of the size, number of tumor foci, age of patients, and other demographic and clinico-pathological parameters. The aims of the present study were to assess the prevalence of multifocality in hereditary (hMTC) and sporadic (sMTC) patients and to correlate the presence of multifocality with clinico-pathological parameters to provide a proof of concept that lobectomy can be safely performed in selected cases.
We analyzed the epidemiological, pathological, and clinical data of 389 MTC (311 sMTC and 78 hMTC) diagnosed in our center from 2005 to 2018.
Multifocality was found in 89/389 cases (22.9%), (45/311 (14.5%) sMTC and 44/78 (56.4%) hMTC). Bilaterality was detected in 27/311 (8.7%) of all sMTC, particularly in 27/45 (60%) of multifocal ones, and in 44/78 of hMTC (56.4%). Multifocality was correlated with a more aggressive phenotype in both sMTC and hMTC, and the multivariate analysis showed that it was statistically and independently associated with tumoral extrathyroidal extension and N1 status in sMTC and with N1 status and persistent disease in hMTC. However, none of the presurgical factors could predict the presence of both multifocality and bilaterality.
Our study demonstrated that the rarity of multifocality and, in particular, of bilaterality, in sMTC represents the proof of concept for considering a more conservative surgical approach in selected sMTC cases. This approach cannot be considered in hMTC due to the high prevalence of multifocal and bilateral cases.
目前，全甲状腺切除术和中央区颈淋巴结清扫术是推荐用于甲状腺髓样癌（MTC）初始治疗的手术方式，与肿瘤大小、病灶数量、患者年龄以及其他人口统计学和临床病理参数无关。本研究的目的是评估遗传性（hMTC）和散发性（sMTC）患者多灶性的发生率，并将多灶性的存在与临床病理参数相关联，以提供在特定病例中可安全进行甲状腺叶切除术的概念验证。
我们分析了2005年至2018年在本中心诊断的389例MTC（311例sMTC和78例hMTC）的流行病学、病理和临床数据。
在89/389例（22.9%）中发现多灶性，其中45/311例（14.5%）sMTC和44/78例（56.4%）hMTC。在所有sMTC的27/311例（8.7%）中检测到双侧性，特别是在多灶性sMTC的27/45例（60%）中，以及在44/78例hMTC（56.4%）中。多灶性在sMTC和hMTC中均与更具侵袭性的表型相关，多变量分析表明，在sMTC中它与肿瘤甲状腺外扩展和N1状态在统计学上独立相关，在hMTC中与N1状态和持续性疾病相关。然而，术前没有任何因素能够预测多灶性和双侧性的同时存在。
我们的研究表明，sMTC中多灶性尤其是双侧性的罕见性，代表了在特定sMTC病例中考虑采用更保守手术方式的概念验证。由于多灶性和双侧性病例的高发生率，这种方法不适用于hMTC。
