{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:40:01Z","timestamp":1784241601725,"version":"3.55.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017594","name":"Medical Science and Technology Project of Zhejiang Province","doi-asserted-by":"publisher","award":["2025KY721"],"award-info":[{"award-number":["2025KY721"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"publisher"}]},{"name":"General Training Fund of Zhejiang Cancer Hospital","award":["PY2023018"],"award-info":[{"award-number":["PY2023018"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471990"],"award-info":[{"award-number":["82471990"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic role of multifocality in medullary thyroid carcinoma (MTC) is controversial. This study evaluated multifocality\u2019s association with aggressiveness, lymph node metastasis (LNM), and survival, focusing on multifocality-related parameters (such as number of tumor foci, tumor diameter).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 186 MTC cases (136 unifocal, 50 multifocal) with a median 59-month follow-up (95% CI: 52-66). Multivariate logistic analysis and Cox regression models assessed multifocality\u2019s impact on LNM and recurrence, with detailed subgroup analyses. Diagnostic performance of tumor size parameters was evaluated using receiver operating characteristic (ROC) analysis, while survival outcomes were assessed via Kaplan\u2013Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multifocal tumors exhibited significantly more aggressive features, including: (1) higher preoperative calcitonin (1226.7\u2009\u00b1\u2009751.9 vs 706.6\u2009\u00b1\u2009704.2\u2009ng\/L, P\u2009&amp;lt;\u2009.001); (2) increased capsular invasion (68% vs 32%, odds ratio [OR]\u2009=\u20095.8, 95% CI: 2.32-14.53); and (3) more frequent intraglandular spread (54% vs 18%, OR\u2009=\u20096.05, 95% CI: 1.47-24.92). Multifocality independently predicted both LNM (OR\u2009=\u20093.35, 95% CI: 1.22-9.25, P\u2009=\u2009.019) and recurrence (hazard ratio [HR]\u2009=\u20096.59, 95% CI: 2.48-17.53, P\u2009&amp;lt;\u2009.001). ROC analysis identified optimal LNM cut-offs at 13.5\u2009mm (largest focus) and 16.5\u2009mm (total tumor diameter). Subgroup analyses revealed: (1) bifocal conferred highest LNM risk (OR\u2009=\u20098.51 vs unifocal, 95% CI: 1.74-41.69, P\u2009=\u2009.008); (2) recurrence risk showed dose\u2013response relationship with lesion number (bifocal: HR\u2009=\u20094.89, 95% CI: 1.88-12.70, P\u2009=\u2009.001; \u22653 foci: HR\u2009=\u20095.86, 95% CI: 1.54-22.33, P\u2009=\u2009.01). Survival analysis demonstrated significantly worse progression-free survival in multifocal cases (P\u2009&amp;lt;\u2009.001), persisting beyond 2\u2009years (P\u2009=\u2009.001), though overall survival difference was nonsignificant (P\u2009=\u2009.168).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multifocal MTC exhibits aggressive behavior with high LNM and recurrence risks, driven by the number of tumor foci, demonstrating a dose\u2013response relationship. These findings support incorporating multifocality into risk stratification for optimized management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyag065","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:44:24Z","timestamp":1772109864000},"source":"Crossref","is-referenced-by-count":1,"title":["Multifocality as a marker of aggressiveness in medullary thyroid carcinoma: a retrospective cohort analysis of lymph node metastasis and recurrence"],"prefix":"10.1093","volume":"31","author":[{"given":"Yidan","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Taizhou Cancer Hospital , Taizhou, Zhejiang 317502,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2250-1264","authenticated-orcid":false,"given":"Jing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jincao","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Interventional Medicine and Engineering Research Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Wenling Medical Big Data and Artificial Intelligence Research Institute , Taizhou, Zhejiang 317502,","place":["China"]},{"name":"Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Department of Ultrasound, Taizhou Cancer Hospital , Taizhou, Zhejiang 317502,","place":["China"]},{"name":"Interventional Medicine and Engineering Research Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Wenling Medical Big Data and Artificial Intelligence Research Institute , Taizhou, Zhejiang 317502,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Zhejiang Provincial Research Center for Innovative Technology and Equipment in Interventional Oncology, Zhejiang Cancer Hospital , Hangzhou, Zhejiang 310022,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-240X","authenticated-orcid":false,"given":"Dong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Interventional Medicine and Engineering Research Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences , Hangzhou, Zhejiang 310022,","place":["China"]},{"name":"Wenling Medical Big Data and Artificial Intelligence Research Institute , Taizhou, Zhejiang 317502,","place":["China"]},{"name":"Zhejiang Provincial Research Center for 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