Multifocality as a marker of aggressiveness in medullary thyroid carcinoma: a retrospective cohort analysis of lymph node metastasis and recurrence.

Bilaterality demonstrated a higher-risk trend (HR = 2.015, 95% CI: 0.987-6.63) that did not reach statistical significance ( P = .249).

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Although OS curves showed a nonsignificant trend toward separation (OR = 0.168), this aligns with prior observations that MTC-related mortality often lags behind recurrence by years, 29 and high local recurrence rates do not directly impact OS due to effective structural disease control through reoperations. 30 The divergence between PFS and OS underscores the clinical relevance of recurrence as an actionable endpoint, particularly in multifocal cases where early biochemical or structural relapse may guide timely intervention.

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