Relationships between clinicopathological prognostic factors in papillary thyroid microcarcinoma: a refined analysis based on 428 cases.

A clear definition of the prognostic factors for papillary thyroid microcarcinoma (PTMC) is still debatable, as the tumor characteristics which indicate a high risk of metastasis are little known. We investigated the clinicopathological profile of a large group of PTMC, aiming to ascertain possible relationships between a set of clinicopathological characteristics and four parameters expressing tumor extension and aggressiveness (namely lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis). For 428 patients, the following data were retrospectively documented: sex, age, tumor size, histological variant, associated thyroid pathology, location (subcapsular, intraparenchymal), unilateral or bilateral involvement, number of foci, lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis. Data were analyzed using univariate and multivariate logistic regression analysis. Multivariate analysis confirmed that the tumor size is a negative prognostic factor for lympho-vascular invasion, thyroid capsule invasion, extrathyroidal extension and lymph node metastasis. We also demonstrated a strong relationship between the subcapsular location and lympho-vascular and capsule invasion, and extrathyroidal extension. The multifocality was correlated only with thyroid capsule invasion and extrathyroidal extension. Regarding the histological variants, the only validated correlation was between the oncocytic variant and extrathyroidal extension. Our work contributes to the validation of PTMC prognostic factors, useful in stratification of PTMC in high or low risk classes, and able to explain the behavioral differences in the tumor development.