Multifocality Is not an Independent Prognostic Factor in Papillary Thyroid Cancer: A Propensity Score-Matching Analysis.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Despite its low mortality rate, the disease has a recurrence rate of up to 30%. The mainstay of treatment for PTC is surgery, followed by radioiodine ablation and thyroxine therapy in appropriately selected patients. PTC can appear as a unifocal solitary tumor, but also as two or more anatomically separate foci. A great deal of controversy surrounds the significance of multifocality as a prognostic factor, and it is considered a poor prognostic factor that prompts more aggressive treatment. The aim of this study was to investigate the prognostic value of tumor multifocality on disease recurrence and mortality in PTC patients. METHODS: Data of 1039 consecutive PTC patients from two tertiary medical centers were reviewed. The baseline characteristics and short- and long-term outcome were analyzed to evaluate the prognostic significance of multifocal disease. The application of two different propensity score models followed multivariate analysis. RESULTS: The median follow-up was 10.1 years, and 534 (51.4%) patients had multifocal disease and 505 (48.6%) unifocal disease. Patients with the multifocal disease were significantly older, were more frequently male, had more extrathyroidal extension, more lymph node metastases, more advanced disease (stage III/IV), and a higher American Thyroid Association recurrence risk. Multifocal PTC patients had more persistence at one year (26.6% vs. 16.4%; p < 0.001), more recurrence during follow-up (12.7% vs. 6.6%; p = 0.002), and a higher overall mortality rate (15.5% vs. 9.7%; p = 0.002). However, there were no significant differences in recurrence, last-visit persistency, and mortality rates when adjusting for confounding variables by using propensity score matching. CONCLUSION: This propensity score-matching study provides the best available data to support the assertion that multifocality in PTC patients is a marker of more extensive disease at presentation, but not an independent prognostic factor for long-term outcomes.

Long-Term Outcome after Hemithyroidectomy for Papillary Thyroid Cancer: A Comparative Study and Review of the Literature.

Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I131 were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1⁻48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome.

Why are women missing from outpatient cardiac rehabilitation programs? A review of multilevel factors affecting referral, enrollment, and completion.

OBJECTIVES: The objectives of this paper are to (1) systematically review the evidence for patient, provider, and programmatic factors that may influence women's referral to, enrollment in, and completion of outpatient cardiac rehabilitation and (2) make empirically based recommendations for future women's health research. METHODS: Using a defined inclusion/exclusion criteria, this review involved a systematic review and description analysis of the published peer-review literature. RESULTS: The review yielded 23 studies described in 25 publications. Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention. CONCLUSIONS: Practitioners engaged in the care of eligible cardiac patients should be aware of the evidence for the effectiveness of cardiac rehabilitation, and researchers should examine programmatic and provider factors that affect women's participation.