Clinical Implication of the Number of Central Lymph Node Metastasis in Papillary Thyroid Carcinoma: Preliminary Report

Lee, Yoon Se; Lim, Yun Sung; Lee, Jin‐Choon; Kim, In-Ju; Lee, Byung‐Joo

doi:10.1007/s00268-010-0749-0

Cited by 63 publications

(59 citation statements)

References 61 publications

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“…Recurrence-free survival rate according to pathological T stage was 96.7% in T1, 76.5% in T2, and 84.6% in T3, and it seems that pathological T staging is not enough to predict prognosis (hazard ratio 1.53, 95% CI 0.94 to 2.51, PZ0.090). This is not consistent with the previous data (1,10,11,12) and we think that patient selection bias might have led to this conclusion, as only those with tumor size O1 cm were analyzed. Patients with tumor size !1 cm showed overall excellent prognosis and it was not meaningful to analyze the impact of central neck LN metastases.…”

Section: Discussioncontrasting

confidence: 92%

“…These results proved the need for new staging systems to predict accurate risk of recurrence of pN1 patients. This is consistent with the previous studies which showed that increased number of central LN metastases and LN size of larger than 3 cm were associated with poorer prognosis (1,3,10,12,13,14,17). Lang et al (11) also revealed that higher metastatic central LN ratio (over 33.34%) was an independent factor for short-term outcomes estimated by postablative stimulated serum thyroglobulin.…”

Section: Discussionsupporting

confidence: 91%

“…Several studies also suggested that larger size or higher number of metastatic LNs in PTC is associated with poorer outcomes (1,10,11,12,13). A recent review suggested new risk factors that modify standard N1 risk of recurrence such as clinical status, size, number, or presence of extranodal extension of metastatic lesions in LNs (14).…”

Section: Introductionmentioning

confidence: 99%

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The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

Jeon

Yoon

Han

et al. 2013

European Journal of Endocrinology

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Objective: The presence of central neck lymph node (LN) metastases (defined as pN1a according to Tumor Node Metastasis classification) in papillary thyroid cancer (PTC) is known as an independent risk factor for recurrence. Extent of LN metastasis and the completeness of removal of metastatic LN must have an impact on prognosis but they are not easy to measure. Moreover, the significance of the size of metastatic tumors in LNs has not been clarified. This study was to evaluate the impact of the extent of LN metastasis and size of metastatic tumors on the recurrence in pathological N1a PTC. Design: This retrospective observational cohort study enrolled 292 PTC patients who underwent total thyroidectomy with central neck dissection from 1999 to 2005. LN ratio was defined as the number of metastatic LNs divided by the number of removed LNs, which was regarded as variable reflecting both extent of LN metastasis and completeness of resection, and LN size as the maximal diameter of tumor in metastatic LN. Results: The significant risk factors for recurrence in univariate analysis were large primary tumor size (defined as larger than 2 cm), high LN ratio (defined as higher than 0.4), and presence of macrometastasis (defined as larger than 0.2 cm). Age, sex, clinical node status, and microscopic perithyroidal extension had no effect on recurrence. In multivariate analysis, high LN ratio and presence of macrometastasis were independent risk factors for recurrence. Conclusion: LN ratio and size of metastatic nodes had a significant prognostic value in pathological N1a PTC. We suggest that risk stratification of pathological N1a PTC according to the pattern of LN metastasis such as LN ratio and size would give valuable information to clinicians.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

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The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

Jeon

Yoon

Han

et al. 2013

European Journal of Endocrinology

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“…The presence of CLNM warrants greater attention in LLN following thyroidectomy and CLN dissection. LLNM is associated with high rates of recurrence and distant metastasis and should be managed more aggressively when it is suspicious (28). Therefore, given the higher risk of LLN involvement, lateral compartment dissection might be considered a choice for these CLNM positive patients or for those with no less than 2 CLNM (29).…”

Section: Discussionmentioning

confidence: 99%

Risk factors analyses for lateral lymph node metastases in papillary thyroid carcinomas: a retrospective study of 356 patients

Nie

Tan

et al. 2016

Arch. Endocrinol. Metab.

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Objective: The aim of this study was to investigate the incidence and risk factors for lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). Subjects and methods: 356 patients diagnosed with PTC who underwent total thyroidectomy and central lymph node dissection and lateral lymph node dissection between January 2005 and December 2011 were enrolled. The relation between LLNM and clinicopathological features such as gender, age, tumor size, tumor spread, psammoma bodies, tumor multifocality, extrathyroidal extension (ETE), unilateral or bilateral disease, tumor primary location and central lymph node metastases (CLNM) was analyzed. Results: The rate of LLNM was 75.0%. In the univariate analysis, it was significantly associated with age, tumor size, tumor spread, extrathyroidal extension, primary tumor location and central lymph node metastasis (p < 0.05). In contrast, in the multivariate analysis, it was significantly associated with primary tumor location, central lymph node metastasis (p < 0.05) and tumor size > 1.5 cm with p = 0.05 but was unrelated to the other factors. Conclusion: Patients with PTC, with the primary tumor located in the upper part of the lobe and positive central compartment lymph node metastasis with a tumor size > 1.5 cm diameter are more likely to have LLNM. Therefore, more meticulous evaluations including the lateral lymph nodes should be performed before surgery. Arch Endocrinol Metab. 2016;60(5):492-9

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“…In some 5-10% of cases, N1b disease (lateral lymph node metastasis) may skip the central neck, usually in cases where the tumour is located in the upper poles of the thyroid (29). The most widely recognized pathological variable associated with central neck metastasis in advanced PTC is extrathyroidal invasion usually, but not always, associated with large tumours (28,30,31).…”

Section: How Often Is the Central Neck Compartment Involved In Non-mimentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Central neck dissection: a step forward in the treatment of papillary thyroid cancer

Sitges‐Serra

Lorente

Mateu

et al. 2015

European Journal of Endocrinology

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Since its introduction in the '70s and '80s, CND for papillary cancer is here to stay. Compartment VI should always be explored during surgery for papillary thyroid carcinoma (PTC) for obvious lymph node metastases. These can be easily spotted by an experienced surgeon or, eventually, by frozen section. No doubt, obvious nodal disease in the Delphian, paratracheal and subithsmic areas should be dissected in a comprehensive manner (therapeutic central neck dissection), avoiding the selective removal of suspicious nodes. Available evidence for routine prophylactic CND is not completely satisfactory. Our group's opinion, however, is that it reduces or even eliminates the need for repeat surgery in the central neck, better defines the extent (and stage) of the disease and provides a further argument against routine radioiodine ablation. Thus, PTC is becoming more and more a surgical disease that can be cured by optimized surgery alone in the majority of cases. Prophylactic CND, however, involves a higher risk for the parathyroid function and should be skilfully performed, preferably only on the same side as the primary tumour and preserving the cervical portion of the thymus.

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Clinical Implication of the Number of Central Lymph Node Metastasis in Papillary Thyroid Carcinoma: Preliminary Report

Abstract: The number of CLN metastasis correlated with the negative prognostic factors, including tumor size, extrathyroidal extension, and lateral neck lymph node metastasis. This suggests that the number of CLN has prognostic implication.

Cited by 63 publications

References 61 publications

The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

The prognostic value of the metastatic lymph node ratio and maximal metastatic tumor size in pathological N1a papillary thyroid carcinoma

Risk factors analyses for lateral lymph node metastases in papillary thyroid carcinomas: a retrospective study of 356 patients

THERAPY OF ENDOCRINE DISEASE: Central neck dissection: a step forward in the treatment of papillary thyroid cancer

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