Optimal Cut-Off Values of Lymph Node Ratio Predicting Recurrence in Papillary Thyroid Cancer

Lee, Seul Gi; Ho, Jia Shin; Choi, Jun Shik; Kim, Tae Hyung; Kim, Min Jhi; Ban, Eun Jeong; Lee, Cho Rok; Kang, Sang–Wook; Jeong, Jong Ju; Nam, Kee Hyun; Jung, Sang Geun; Jo, Young Suk; Lee, Jandee; Chung, Woong Youn

doi:10.1097/md.0000000000002692

Cited by 32 publications

(34 citation statements)

References 33 publications

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“…Ryu et al report that a LN ratio >0.65 is a significant predictor of recurrence after prophylactic CND in pN1a patients . The optimal cutoff values for LN ratio may require further definition in central and lateral LNs . The adequacy of LN yield for PTC staging may also need to be re‐assessed to enable standardization .…”

Section: Discussionmentioning

confidence: 99%

“…30 The optimal cutoff values for LN ratio may require further definition in central and lateral LNs. 31 The adequacy of LN yield for PTC staging may also need to be reassessed to enable standardization. 32 The present study also showed that a higher number of LNs and the LN ratio were significantly associated with post-treatment recurrence and increased likelihood of ENE.…”

Section: Prediction Of Nodal Metastasis and Enementioning

confidence: 99%

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

Roh

Park

Jeong

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Prediction Of Nodal Metastasis and Enementioning

confidence: 99%

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

Roh

Park

Jeong

et al. 2017

Journal of Surgical Oncology

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“…proposed LNR as an alternative to pN staging in node‐positive breast cancer . In contrast, the relationship between LNR and oncologic outcomes in PTC has focused only on tumor recurrence , not mortality. One study proposed total LNR as a prognostic factor of PTC using the SEER (Surveillance, Epidemiology, and End Results) dataset , but the authors did not adjust for the location of metastatic LNs, which is the most important criteria in N staging of thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size

Kim

Choe

et al. 2017

Cancer Medicine

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The current 7th TNM staging stratifies N1b papillary thyroid cancer (PTC) patients without distant metastasis into either stage I or stage IV merely by an age threshold (45 years). To date, no studies have adequately quantified the mortality risk of PTC patients with N1b disease. We hypothesized that incorporating lymph node (LN) factors into the staging system would better predict cancer‐specific mortality (CSM). A total of 745 nonmetastatic PTC patients with N1b disease were enrolled. We identified factors related to LNs and cut‐points using Cox regression and time‐dependent ROC analysis. New prognostic groupings were derived based on minimal hazard differences for CSM among the groups stratified by LN risk and age, and prediction of CSM was assessed. Lateral lymph node ratio (LNR) and largest LN size were significant prognostic LN factors at cut‐points of 0.3 and 3 cm. Without LN risk (lateral LNR >0.3 or largest LN size >3 cm), stage IV patients had prognosis [adjusted HR 1.10 (98% CI 0.19–6.20); P = 0.906] similar to stage I patients with LN risk. Patients were restratified into three prognostic groups: Group 1, <45 years without LN risk; Group 2, <45 years with LN risk or ≥45 years without LN risk; and Group 3, ≥45 with LN risk. This system had a lower log‐rank P‐value (<0.001 vs. 0.002) and higher C‐statistics (0.80 vs. 0.71) than the 7th TNM. New prognostic grouping using lateral LNR and largest LN size predicts CSM accurately and distinguishes N1b patients with different prognosis.

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“…PTC is the most common histological type of thyroid cancer and elicits good therapeutic response to surgery and radioiodine treatment. For patients with advanced stage PTC, LNR has been suggested to be useful to predict prognosis by several studies [ 21 , 22 ]. We confirmed that LNR was associated with DSS in patients with advanced stage by univariate and multivariate Cox regression analysis ( P < 0.05), illustrating the contribution of LNR to the risk of disease specific death.…”

Section: Discussionmentioning

confidence: 99%

Ratio of positive lymph nodes: The prognostic value in stage IV thyroid cancer

Jiang

Huang

et al. 2017

Oncotarget

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To assess the prognostic value of lymph node ratio (LNR) in patients with stage IV thyroid cancer based on the Surveillance, Epidemiology, and End Results (SEER) database. A total of 4,940 eligible patients were included for the analysis. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to reveal the effect of LNR on overall survival (OS) and disease specific survival (DSS). The optimal cut-off value of LNR for predicting OS and DSS was determined by the time-dependent Receiver Operating Characteristic analysis. By the univariate Cox proportional hazard regression, LNR was significantly associated with OS and DSS in patients with medullary thyroid cancer (MTC), papillary thyroid cancer and anaplastic thyroid cancer (all P < 0.05). With the optimal cut-off value, Kaplan-Meier analysis showed that MTC patients with LNR≥76.5% were significantly associated with poorer OS (log-rank test: P < 0.0001), and LNR≥40.7% were significantly associated with poorer DSS (log-rank test: P < 0.0001). LNR was an independent prognostic factor of poorer survival in MTC patients after adjusting for other variables by multivariable Cox analysis (OS: hazard ratio [HR] = 2.560, 95% confidence interval [CI] 1.690–3.879, P < 0.0001; DSS: HR=2.781, 95% CI 1.582–4.888, P = 0.0004). Our results demonstrated that LNR could predict clinical outcomes in patients with stage IV MTC, and 76.5% was the optimal cut-off value of LNR to predict OS. LNR, as a function of the nodes positive and the nodes examined, could provide suggestions on the postoperative prognosis of patients with stage IV MTC.

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Optimal Cut-Off Values of Lymph Node Ratio Predicting Recurrence in Papillary Thyroid Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 32 publications

References 33 publications

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

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

Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size

Ratio of positive lymph nodes: The prognostic value in stage IV thyroid cancer

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