Lymphovascular invasion is associated with survival for papillary thyroid cancer

Abstract

Data are limited regarding the association between tumor lymphovascular invasion and survival for patients with papillary thyroid cancer (PTC). This study sought to examine lymphovascular invasion as an independent prognostic factor for patients with PTC undergoing thyroid resection. The National Cancer Data Base (2010-2011) was queried for patients with PTC who underwent total thyroidectomy or lobectomy. Patients were classified into two groups based on the presence/absence of lymphovascular invasion. Demographic, clinical and pathological features were evaluated for all patients. A Cox proportional hazards model was utilized to identify factors associated with survival. Results show that 45,415 patients met inclusion criteria; 11.6% had lymphovascular invasion. Patients with lymphovascular invasion were more likely to have larger tumors (2.8 cm vs 1.5 cm, P < 0.01), metastatic lymph nodes (74.1% vs 32.5%, P < 0.01), and distant metastases (3.0% vs 0.5%, P < 0.01). They were also more likely to receive radioactive iodine (69.3% vs 44.9%, P < 0.01). Unadjusted overall 5-year survival was lower for patients who had tumors with lymphovascular invasion (86.6% vs 94.5%) (log-rank P < 0.01). After adjustment, increasing patient age (HR = 1.06, P < 0.01), male gender (HR = 1.68, P < 0.01), presence of metastatic lymph nodes (HR = 1.77, P < 0.01), distant metastases (HR = 3.49, P < 0.01), and lymphovascular invasion (HR = 1.88, P < 0.01) were associated with compromised survival. For patients with lymphovascular invasion, treatment with RAI was associated with reduced mortality (HR = 0.43, P < 0.01). The presence of lymphovascular invasion among patients with PTC is independently associated with compromised survival. Patients who have PTC with lymphovascular invasion should be considered higher risk, and adjuvant RAI should be more strongly considered.

Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma

“…In another study, LVI was determined in 4.9% of PTC patients (n = 662) [38]. The largest study investigating the association between LVI and PTC was published by Pontius et al [25]. The authors reported 11.6% incidence of LVI in PTC patients [25].…”

“…In another study conducted by Xu et al [22], extensive vascular invasion (EVI) was an independent predictor of poor recurrence-free survival in low-grade encapsulated follicular cell-derived thyroid carcinomas (LGEFCs), and patients with EVI may be considered for more aggressive treatment modalities. Data on the association between LVI and clinicopathological features of PTC are limited to small case series, and conflicting results have been reported [23][24][25][26]. In this study, we investigated the relationship between the presence of LVI and clinical features and histopathological outcomes of PTC patients.…”

A novel integrative risk index of papillary thyroid cancer progression combining genomic alterations and clinical factors

“…Recurrence rates have been reported to be as high as 20–30%, and more than 10% of patients die as a result of disease progression [5, 6]. Some patient-related factors such as advanced age at diagnosis, larger tumor size, cervical lymph node metastases, extrathyroidal extension, and lymphovascular invasion have been associated with an increased risk of disease progression at a population level, but they lack the precision to perfectly tailor surveillance and treatment strategies and anticipate prognosis [7]. …”

Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

“…Definitions of LVI vary from author to author, and there are issues of overdetection with artifacts, all of which contribute to the confusion regarding this particular pathologic finding [6]. In other malignancies, such as thyroid [7], lung [8], stomach [9], bladder [10], kidney [11], and breast cancers [12], LVI is considered as an independent prognostic factor. Regarding the prostate, despite the unclear prognostic value of LVI in prior studies conducted in the general population, more recent investigations of patients in particular stages show some promising aspects [1, 13, 14].…”