Lymph node density in papillary thyroid carcinoma is a prognostic factor after adjusting for pathological stage

Abstract

We investigated the possible association between the lymph node density and survival outcomes in differentiated papillary thyroid carcinoma, and examined whether the lymph node density was a predictor in a multivariate analysis adjusted for the pathological stage in the eighth edition of the Union for International Cancer Control Tumor-Node Metastasis Classification of Malignant Tumors. A total of 543 patients with papillary thyroid carcinoma were enrolled. We performed restaging according to the eighth edition. The lymph node density was the ratio between number of positive lymph nodes and total number of excised lymph nodes. A log-rank test and Cox's proportional hazards model were used for univariate and multivariate analysis with adjustment for the pathological stage in the eighth edition, respectively. In both the univariate and multivariate analyses of 150 patients with pN1bM0, the presence of a lymph node density of ≥ 0.3 with pN1b was significantly associated with shorter disease-specific survival. In both the univariate and multivariate analyses of all 543 patients, a lymph node density of ≥ 0.3 with pN1b were also significantly associated with shorter overall and disease-specific survival. In conclusion, these results suggest that the lymph node density can be used as a predictor for the survival outcomes after adjustment for the pathological stage in the eighth edition.

Uptake of 18F-Fluorodeoxyglucose in Major Salivary Gland Cancer Predicts Survival Adjusting for Pathological Stage

“…Our present findings, which showed a significant association between high FDG-uptake parameters and shorter OS, are consistent with those in previous studies (8,(13)(14)(15). Pathological stage by restaging based on using the eighth edition of the staging manual AJCC and UICC8 has been showed to be a useful predictor in several types of cancer (3,6,7). In 4,520 patients with salivary gland cancer from the National Cancer Database in United States of America, restaging stage such as pN3b was significantly associated with survival outcomes (6).…”

“…In 4,520 patients with salivary gland cancer from the National Cancer Database in United States of America, restaging stage such as pN3b was significantly associated with survival outcomes (6). We also showed that the pathological stage by restaging was significantly associated with OS in 543 patients with papillary thyroid cancer (7). Recently, we showed the significant association between 18 F-FDG-uptake parameters of primary tumor and OS in 28 patients with oral cancer by multivariate analysis adjusting for UICC8 pathological stage (3).…”

Predictive value of metastatic lateral lymph node ratio for recurrence in pathologically lateral lymph node‐positive papillary thyroid cancer patients with palpable lymph nodes

“…28 Suzuki et al reported that LNR of LLNs ≥0.3 were significantly associated with poorer overall and disease-specific survival. 29 Schneider et al also found LNR ≥0.42 was a strong determinant of shorter disease-specific survival. 30 Previous studies have investigated the prognostic impact of LNR of CLNs alone or CLNs and LLNs together.…”

“…Gao et al compared the prognostic value of number and LNR of metastatic lymph nodes on clinical response in PTC and pointed out that LNR seemed to negatively predict excellent response better than the number of metastatic lymph nodes in PTC patients with ≤10 dissected lymph nodes, whereas the opposite trend was observed in those with >10 dissected lymph nodes 28 . Suzuki et al reported that LNR of LLNs ≥0.3 were significantly associated with poorer overall and disease‐specific survival 29 . Schneider et al also found LNR ≥0.42 was a strong determinant of shorter disease‐specific survival 30 .…”

Superiority of metastatic lymph node ratio over number of node metastases and TNM/AJCC N classification in predicting cancer‐specific survival in medullary thyroid cancer

“…Generally, there is no good reason to suppose that there is an underlying dichotomy. 16 In spite of this, most cancer-specific survival studies employed dichotomization, producing metastatic lymph node ratio cutpoints which varied from 0.19 for MTC 14 to 0.3 for both papillary thyroid cancer 17 and poorly differentiated thyroid cancer. 18 However, findings deriving from papillary thyroid cancer and poorly differentiated thyroid cancer, originating from follicular thyroid cells that synthesize thyroid hormones, cannot be generalized to MTC, a neuroendocrine malignancy originating from parafollicular C cells that synthesize calcitonin.…”