Prognostic Factors for Persistent or Recurrent Disease of Papillary Thyroid Carcinoma with Neck Lymph Node Metastases and/or Tumor Extension beyond the Thyroid Capsule at Initial Diagnosis

Abstract

We highlight an excellent survival rate and suggest risk classifications of persistent and recurrent disease based on the numbers of LN metastases and ECE-LN, LN metastases location, tumor size, and thyroglobulin level.

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

“…For this reason, although the size of the LN and metastatic foci was not available for our patients, the fact that US was negative ensures the absence of LNM > 3 cm and makes LNM > 1.5 cm highly unlikely. Although defined as an exclusion criterion of the present study, macroscopic extranodal invasion is uncommon in the case of small LNM (16,20,38) and not present in large numbers (15,16,38). In fact, extranodal invasion was observed in only 7/466 patients with LNM < 3 cm and up to 5 positive LN in a previous series (16) and in only 1/87 patients with negative US and up to 5 positive LN in the present study (data not shown).…”

“…There was no case of death due to the disease. (9)(10)(11)(12)(13)(14), the presence of more than 5 positive LN (11,(15)(16)(17)(18), metastases ≥ 3 cm (11,16,19), and extranodal extension (15,16,(18)(19)(20)(21) are also associated with a poor prognosis (4,5,7,22). In these cases, there is little controversy about the need for a more aggressive initial approach.…”

“…in patients younger than 45 years (17) and by Leboulleux and cols. (15). It should also be noted that the patients had LNM that were detected during intraoperative inspection (cN1), and it could be possible that the rate of persistent disease and tumor recurrence are even lower among patients with LNM detected only during elective neck dissection (cN0pN1).…”

“…Furthermore, the risk of persistent disease [defined as metastases on initial posttherapy whole body scanning (RxWBS) or detected by the imaging methods until one year after ablation] and tumor recurrence (defined as strutural disease diagnosed more than one year after ablation) is significantly increased when LNM are detected by preoperative US (9)(10)(11)(12)(13)(14), in the presence of numerous [> 5 positive LN (11,(15)(16)(17)(18)] and large LNM [≥ 3 cm (11,16,19)], or in the presence of extranodal tumor extension (15,16,18-21).…”

Prophylactic Level VII Nodal Dissection as a Prognostic Factor in Papillary Thyroid Carcinoma: a Pilot Study of 27 Patients

“…Putting in mind that in PTC, lymph node metastases have been shown to increase the risk of locoregional tumor recurrence (Hay et al, 1999;Leboulleux et al, 2005;Cheema et al, 2006;Ito and Miyauchi, 2007) and that approximately 5% of patients with PTC were identified as having superior mediastinal metastases (Roh et al, 2008;Machens and Dralle, 2009) with concerns that metastatic lymph node involvement is nothing more than indolent microscopic disease without clinical significance and that the sensitivity of ultrasound and CT range between only 50 and 70 % Mulla, (2012), and on the other hand Wang et al, 2013 advocated the unnecessary CND in some patients with incidental PTC postoperatively and that the impact of positive regional lymph nodes on survival has been controversial (Steinmuller et al, 2000), we performed a prophylactic CND including level VI and VII from the same collar neck incision (Block et al, 1972). Yu et al, 2012 recommended the "wait and see" strategy for clinically negative level V in low risk PTC patients and stated that it would still achieve good survival results.…”