Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma

Kim, S. K.; Park, I.; Hur, Nayoon; Choe, Jun-Ho; Kim, J.‐H.; Kim, J. S.

doi:10.1002/bjs.10514

Cited by 16 publications

(22 citation statements)

References 44 publications

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“…Level IV was the most frequently involved region, followed by levels III and II. Such high rates of metastasis for these three compartments (levels II, III and IV) were considered to be most common in N1b PTC patients, which is in-line with previous studies 3,12-14. Kim J.S.…”

Section: Discussionsupporting

confidence: 88%

“…Kim J.S. et al 12 demonstrated that the incidence of multilevel metastasis was 73.9% among 638 N1b patients, and this incidence was reported as being from 62.3% to 80% in several studies 15-17. In our study, which included a large sample size, 1037 N1b PTC patients, the rate of level V metastasis was 21.3%, and this ranged from 8% to 25.3% in other series 3, 18-22.…”

Section: Discussionsupporting

confidence: 49%

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Nomogram for predicting level V lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: A large retrospective cohort study of 1037 patients from FDUSCC

Wang¹,

Guan²,

Xiang³

2019

J. Cancer

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Objective: Extensive lateral neck dissection (LND), especially routine level V dissection, may potentially increase morbidity and have no significant benefit to survival in patients with papillary thyroid carcinoma (PTC). Our study aimed to determine the pattern and risk factors for level V lymph node metastasis (LNM) and to develop an assessment model based on a nomogram for predicting whether level V dissection is necessary.Methods: A total of 1037 PTC patients with clinically suspected LNM (N1b) who underwent total thyroidectomy (TT) with central LND and unilateral LND from 2011 to 2015 were retrospectively retrieved. Univariate and multivariate analyses were performed to examine risk factors associated with level V metastasis. A nomogram for predicting level V metastasis was established and internally validated.Results: The overall rate of level V metastasis was 21.3% (221/1037). Unilateral central LNM (CLNM), level II/III/IV metastasis, extra nodal extension (ENE) and lymph node (LN) size ≥2 cm were found to be independent predictive factors for level V metastasis (P<0.05). In the nomogram, ENE was confirmed as the largest contributor to scores, followed by LN size, unilateral CLNM and level IV/III/II metastasis. The discrimination of the prediction model was 0.738 (95% confidence interval (CI): 0.703-0.773, P<0.001).Conclusions: The rate of level V metastasis in N1b PTC patients was apparently lower than that of other levels. With the help of our nomogram, a modified lateral neck dissection encompassing levels II-V and a strictly postoperative evaluation may be indicated when the patient has a high score.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 49%

Nomogram for predicting level V lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: A large retrospective cohort study of 1037 patients from FDUSCC

Wang¹,

Guan²,

Xiang³

2019

J. Cancer

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“…Previous studies ( 24 , 25 ) have reported that the rate of lateral multiple-level metastasis after MRND in N1b papillary thyroid carcinoma (PTC) patients was greater than 70%. However, we found that the overall incidence of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, which is partly due to the possibility of occurrence of the lateral LNM in PTMC patients, and 70 N1b PTMC patients (49.3%) underwent conservative SND in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Likhterov and colleagues ( 26 ) revealed that the incidence of lateral LNM significantly increased with the CPLN. Kim et al ( 24 ) have reviewed 658 N1b PTC patients and demonstrated that the bilateral central LNM (OR = 4.06, 95% CI: 2.29–7.18) and the unilateral central LNM (OR = 2.45, 95% CI: 1.53–3.92) were independent predictors for the lateral multilevel metastasis. In our research, the CPLN in patients with lateral multiple-metastasis was significantly higher than in patients where the lateral multiple-metastasis was absent (5.83 ± 4.14 vs. 2.53 ± 2.34, P < 0.001), and, to elucidate the quantitative relationship between the lateral and central LNM, we used the ROC curve analysis that revealed the optimal cut-off values of CPLN was 4.5, while CPLN values ≥ 5 were significantly associated with lateral multiple-level metastasis ( P < 0.001), which is in accordance with Bohec’s study ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

et al. 2020

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Background: The optimal extent of therapeutic lateral neck dissection (LND) in the management of N1b papillary thyroid microcarcinoma (PTMC) is still under debate in clinical practice. In this light, our study aims to explore the incidence, patterns, and predictive factors of the lateral multiple-level metastasis in N1b PTMC patients. Methods: The clinical records of 142 patients diagnosed with N1b PTMC who underwent therapeutic LND from July 2015 to November 2018 at our institution were retrospectively reviewed. Univariate and multivariate analyses were conducted to examine the predictive factors associated with lateral multiple-level metastasis. The recurrence-free survival was analyzed and confirmed by Kaplan–Meier plots and log-rank test. Results: The overall frequency of lateral multiple-level metastasis was 50.7% in N1b PTMC patients, and two-level to four-level simultaneous metastasis were present in 26.8, 17.6, and 6.3% patients, respectively. Extrathyroidal extension (ETE) (OR = 5.79, 95% CI, 1.36–24.59; P = 0.017) and the central metastatic lymph node ratio (CLNR) with values equal or higher than 0.61 (OR = 6.18, 95% CI, 2.53–15.09; P < 0.001) served as independent predictors of multiple-level metastasis in N1b PTMC patients. Moreover, locoregional recurrence was significantly higher in the selective neck dissection (SND) group compared to the modified radical neck dissection (MRND) one (HR = 3.65, 95% CI, 1.11–12.00; P = 0.03). Conclusion: Our results show that the lateral multiple-level metastasis was relatively common, and we suggest MRND to be considered for N1b PTMC patients with ETE or CLNR equal or higher than 0.61.

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“…A 30 mCi 131I scan was used to detect distant metastasis. We defined PTC recurrence as a structurally incomplete response during the short-term follow-up, as described in the ATA guidelines [ 2 ] and other reports [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Using a nomogram based on preoperative serum fibrinogen levels to predict recurrence of papillary thyroid carcinoma

Lei

Gong

et al. 2018

BMC Cancer

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BackgroundHyperfibrinogenemia is increasingly being recognized as an important risk factor related to cancer stage, development and outcomes. We evaluated whether preoperative serum fibrinogen levels predict recurrence of papillary thyroid carcinoma (PTC).MethodsWe retrospectively collected data for 1023 PTC patients who underwent surgery at our institution from Aug 2014 to Aug 2016. In total, 414 patients (from Aug 2014 to Dec 2015) were used as the training set to build the model, and 609 patients (from Jan 2016 to Aug 2016) were used as the testing set to validate the model.ResultsIn the training set, PTC cases with high serum fibrinogen levels were more likely to have multiple PTCs (P = 0.001) and to exhibit surrounding tissue or organ invasion (both P < 0.01). Moreover, PTC patients with higher serum fibrinogen levels were also more likely to have an advanced tumor stage (T, P = 0.001) and distance metastasis (P < 0.001), and these patients had a significantly higher rate of postoperative PTC recurrence (P = 0.002). All of these findings were validated in the testing set. The results of univariate and multivariate analyses indicated that hyperfibrinogenemia was a risk factor for PTC recurrence. The identified risk factors were incorporated into a nomogram and validated using the testing set (C-index = 0.811, 95% CI: 0.762–0.871).ConclusionPTC cases with hyperfibrinogenemia are more likely to have an advanced TNM stage and have a higher rate of PTC recurrence. Our nomogram could be used to objectively and accurately predict PTC recurrence in a clinical setting.

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Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma

Abstract: Level V metastasis rather than multilevel metastasis itself is associated with an increased risk of LRR. Patients with N1b PTC and level V metastasis require risk restratification and meticulous follow-up.

Cited by 16 publications

References 44 publications

Nomogram for predicting level V lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: A large retrospective cohort study of 1037 patients from FDUSCC

Nomogram for predicting level V lymph node metastases in papillary thyroid carcinoma with clinically lateral lymph node metastases: A large retrospective cohort study of 1037 patients from FDUSCC

Management of Lateral Multiple-Level Metastasis in N1b Papillary Thyroid Microcarcinoma

Using a nomogram based on preoperative serum fibrinogen levels to predict recurrence of papillary thyroid carcinoma

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