Abstract
A minority of papillary thyroid carcinoma (PTC) is highly aggressive, with rapid progression and a poor prognosis. This study investigated the clinical implications of preoperative multi-genic assay in identifying aggressive PTC and initial surgical management. The demographic data, clinicopathological data and preoperative multi-genic assay results of 251 patients with PTC after the initial surgery admitted to the First Affiliated Hospital of Chongqing Medical University from June 2022 to October 2023 were retrospectively analyzed. The results of preoperative multi-genic assay were categorized into three Molecular Risk Groups (MRGs) : MRG-Low, MRG-Intermediate, and MRG-High. 6.7% of patients belonged to MRG-High in this cohort study. Compared with MRG-Low and MRG-Intermediate, there was a significant increase in tumor size, capsular invasion, extrathyroidal extension (ETE), TNM stage, total thyroidectomy (TT) and radioiodine ablation in MRG-High. The multivariate analyses showed MRG-High was an independent predictor for high prevalence of ETE [OR = 83.343(10.074-689.477), P < 0.001]. However, MRG-High was not associated with lymph node metastases(LNM). Conversely, MRG-Low had lower rates of LNM [OR = 0.11 (0.02–0.6), p = 0.011]. Additionally, preoperative multi-genic assay could avoid 20.9% of complete total thyroidectomy in the MRG-Intermediate. This study found that preoperative multi-genic assay is useful to identify the aggressiveness of PTC, which is helpful to the choice of initial surgical management.