Extranodal extension of lymph node metastasis as a prognostic indicator of recurrence and survival in papillary thyroid carcinoma

Roh, Jong–Lyel; Park, Jun Woo; Jeong, Junhyeop; Gong, Gyung Yub; Cho, Kyung–Ja; Choi, Seung‐Ho; Nam, Soon Yuhl; Kim, Sang Yoon

doi:10.1002/jso.24713

Cited by 36 publications

(34 citation statements)

References 36 publications

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“…When considering previous studies (5)(6)(7)9,(22)(23)(24)(25), including a recent meta-analysis (8), it seems clear that the presence of ENE is a significant adverse prognostic factor in thyroid cancer. However, the presence and number of ENEs are closely linked with the number of positive LNs, which makes it difficult to incorporate ENEs into the current riskstratification system.…”

Section: Figmentioning

confidence: 99%

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Impact of Extranodal Extension on Risk Stratification in Papillary Thyroid Carcinoma

Kim

Hyeon

Park

et al. 2019

Thyroid

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Background: The current American Thyroid Association risk-stratification system for papillary thyroid carcinoma (PTC) incorporates the number and size of positive lymph nodes (LNs) but places less weight on extranodal extension (ENE). This study investigated how to incorporate ENE into the current system to predict recurrence better in PTC N1 patients. Methods: A total of 369 N1 PTC patients without distant metastasis were enrolled. The combination of number of positive LNs and LNs with ENE that had the highest C-index were identified with multivariable Cox proportional hazards models. ENE number was incorporated into the current system considering the recurrence rate and unadjusted and adjusted hazard ratios (HRs) of the subgroups. Kaplan-Meier curves for recurrence based on current and alternative systems were compared by log-rank test. Results: The recurrence rate for the subgroup with five or fewer positive LNs and one to three ENEs (7/61; 11.5%) was higher than that of the subgroup with five or fewer positive LNs without ENE (5/129; 3.9%; adjusted HR = 3.42 [confidence interval (CI) 0.99-11.75]; p = 0.050). In contrast, adjusted HRs of the subgroup with more than five positive LNs and one to three ENEs (2.33 [CI 0.52-10.35]) or with four or more ENEs (3.86 [CI 1.05-14.17]) were not higher than those of the subgroup with more than five LNs without ). Incorporating ENE into the current system as an intermediate-risk group yielded a lower log-rank p-value (0.05 vs. 0.01) than the current system. Conclusions: The presence of ENE in low volume LN metastasis confers an intermediate risk of recurrence.Incorporating ENE into the current system allows more accurate decisions regarding further management of PTC N1 patients.

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Section: Figmentioning

confidence: 99%

“…The presence of extranodal extension (ENE), which is a well-known adverse prognostic factor for various cancer types (2)(3)(4), has emerged as an important risk factor for the recurrence of PTC (5)(6)(7)(8). Furthermore, Leboulleux et al suggested that the number of ENEs is associated with an increased risk of recurrence of PTC (9).…”

Section: Introductionmentioning

confidence: 99%

Impact of Extranodal Extension on Risk Stratification in Papillary Thyroid Carcinoma

Kim

Hyeon

Park

et al. 2019

Thyroid

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“…Another intriguing proposal concerns the lymph node capsule-sprouting growth of metastases of thyroid carcinoma, which presents a scientifically documented prognostic value (see also Table 1) (20). In particular, the categories pN1a and pN1b have been subdivided into the subcategories pN1a1/pN1b1, when metastases were limited to the affected lymph nodes or pN1a2/pN1b2, when metastases exhibited extranodal spread.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the concept of "minimal extrathyroid spread" of thyroid carcinomas in the context of the special anatomical conditions of the thyroid gland and its limiting structures must be more precisely histomorphologically defined than before (6,(12)(13)(14)(15)(16). Nevertheless, the clinical impact of minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma is still controversial (17)(18)(19)(20).…”

Section: Th Edition Of the Tnm Classification Of Thyroid Carcinomasmentioning

confidence: 99%

Pitfalls in the 2017 TNM Classification of Thyroid Carcinoma

et al. 2018

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The objective of this article is to detail the 2017 tumor-node-metastasis (TNM) staging criteria for thyroid cancer. The literature presents only few contributions, with controversial results, about comparison between previous and the new TNM systems. The 2017 TNM classification categorizes either thyroid carcinomas only limited to the gland either carcinomas macroscopically infiltrating into defined anatomical structures. The "minimal extrathyroid spread" into the perithyroidal adipose tissue no longer appears as a classification parameter in the new TNM. In the present paper is discussed for the pT categories pT1a, pT1b, pT2, and pT3a. In detail, the T-categories pT1a, pT1b, pT2, and pT3a are each subdivided into true thyroid-restricted carcinomas (pT1a1, pT1b1, pT2a1, and pT3a1) and "minimal extrathyroid proliferation" carcinomas (pT1a2, pT1b2, pT2b, and pT3a2). As a basis, a strict definition of the "minimal extrathyroid propagation" of thyroid carcinomas is essential. Although the suggestion made with the additional substrate characterization makes the work of the pathologist more intricate in daily use, standardized fundamentals for demonstrating or excluding the prognostic and therapeutic relevance concerning a "minimal extrathyroid extension" in thyroid carcinoma appear to be necessary. PREFACEMany efforts have been made to reach a higher accuracy in the tumor staging classifications (1). Tumor staging classifications demand to be constantly updated to latest clinical, anatomic, numeric criterion, pathological, molecular biology, genetics and biochemical findings in order to fulfill their function of internationally accepted standardization and comparability of objective pathological data as the basis for managing patients with malignant diseases (1).Specific standards have to be considered for the determination of the anatomical spread of malignant tumors by the clinical tumor-node-metastasis (cTNM) and pathological tumor-node-J Endocr Surg. 2018 Jun;18(2):98-109 https://doi.

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“…Roh et al, from Asan Medical Center in Korea reviewed their experience of 2071 patients undergoing thyroidectomy . Forty‐seven percent of these patients had positive nodes, while microscopic extranodal extension was noted in 13% and macroscopic extranodal extension was noted in 3.4% (70 patients).…”

mentioning

confidence: 99%

Implications of extra nodal extension in differentiated thyroid cancer

Nixon

Shaha

2017

Journal of Surgical Oncology

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Extranodal extension of lymph node metastasis as a prognostic indicator of recurrence and survival in papillary thyroid carcinoma

Abstract: Macroscopic ENE has a significant adverse impact on recurrence and survival after treatment for PTC. ENE is considered a high risk factor for recurrence.

Cited by 36 publications

References 36 publications

Impact of Extranodal Extension on Risk Stratification in Papillary Thyroid Carcinoma

Impact of Extranodal Extension on Risk Stratification in Papillary Thyroid Carcinoma

Pitfalls in the 2017 TNM Classification of Thyroid Carcinoma

Implications of extra nodal extension in differentiated thyroid cancer

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