Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer

Abstract

We studied the records of 342 patients with papillary thyroid carcinoma out of a total of 728 thyroid cancer patients treated at the Medical School of Hannover (MHH) from 1972 through 1992. The comprehensive data-abstracting forms were designed, and the acquired information was coded, stored, maintained, and evaluated by the Clinical Cancer Registry of the MHH. A total of 160 patients (46.8%) initially had lymph node metastases (N1 status). The N status significantly influenced recurrence (p < 0.00001) and survival (p < 0.00001). Excluding other risk factors developed by univariate and multivariate analysis, such as high age (age > 45 years, p < 0.001), tumor invasion (T4 tumor, p < 0.005), and distant metastases (M1, p < 0.001), lymph node metastases remained an independent, highly significant prognostic marker for more aggressive papillary thyroid cancer. N1 status did not influence survival of patients with T4 tumor but did influence those with T1-T3 status (p < 0.001). The influence of N1 status remained significant in patients older (p < 0.001) and younger (p < 0.05) than 45 years of age. Systematic compartment-oriented dissection of lymph node metastases improved survival (p < 0.005, T1-T3) and recurrence (p < 0.00001, T1-T3) especially in patients with T1-T3 tumors. In conclusion, lymph node metastases with a significant incidence at a young age and male sex had a substantial effect on survival and recurrence especially in those with tumor status T1-T3. Systematic compartment-oriented dissection of the lymph node metastases results in better survival and a lower recurrence rate.

Risk factors for level V lymph node metastases in solitary papillary thyroid carcinoma with clinically lateral lymph node metastases

“…Patients with PTC have excellent prognosis; however, the presence of LNM significantly increases the risk of locoregional recurrence, and some groups have demonstrated decreased disease‐free survival rate and increased mortality associated with regional LNM 4, 5, 6, 7, 8, 9, 10. Extensive LND has the potential to decrease regional recurrence and increase disease‐free survival, but may lead to clinically important postoperative morbidities 13, 14, 15.…”

“…Cervical LNM in PTC have been identified as an independent risk factor for regional recurrence 4, 5, 6, 7, and emerging evidences from large population‐based studies have indicated decreased disease‐free survival rate and increased mortality associated with regional LNM 7, 8, 9, 10. There is universal agreement that therapeutic lateral neck dissection (LND) should be undertaken in patients with PTC and clinically lateral LNM (LLNM) on the basis of palpation or imaging examination 11, 12.…”

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…Differentiated thyroid carcinoma (particularly papillary carcinoma) involves cervical lymph nodes in 20%-50% of patients in most series using standard pathologic techniques (75)(76)(77)(78)(79), and may be present even when the primary tumor is small and intrathyroidal (37,80). The frequency of micrometastases may approach 90%, depending on the sensitivity of the detection method (81,82).…”

Safety and Prognostic Impact of Prophylactic Level VII Lymph Node Dissection for Papillary Thyroid Carcinoma

“…Given the high rate of subclinical nodal metastases in PTC, many centers, have moved to routine prophylactic central nodal dissection (pCND) at the time of total thyroidectomy (TT) for all patients with PTC, pCND allows for more accurate assessment of nodal status, decreases the rate of local recurrence, reduces morbidity from reoperation if required, and may guide the dose of ablative postoperative radioiodine given (Mazzaferri EL Jhiang 1994;Scheumann et al, 1994;Hughes et al, 1996).…”

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Asian Pac J Cancer Prev, 16 (18), 8425-8430

IntroductionPapillary thyroid cancer (PTC) is the most common type of thyroid cancer accounting for about 80% of all thyroid cancers, and is the fifth leading malignancy in females (Cisco et al, 2012;Siegel et al, 2013).Given the high rate of subclinical nodal metastases in PTC, many centers, have moved to routine prophylactic central nodal dissection (pCND) at the time of total thyroidectomy (TT) for all patients with PTC, pCND allows for more accurate assessment of nodal status, decreases the rate of local recurrence, reduces morbidity from reoperation if required, and may guide the dose of ablative postoperative radioiodine given (Mazzaferri EL Jhiang 1994;Scheumann et al, 1994;Hughes et al, 1996).Dralle (2012)

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