Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study

Suman, Paritosh; Wang, Chi‐Hsiung; Abadin, Shabirhusain S.; Moo‐Young, Tricia A.; Prinz, Richard A.; Winchester, David J.

doi:10.1016/j.surg.2015.08.032

Cited by 44 publications

(24 citation statements)

References 21 publications

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“…26 Add to this, ages <45 years were an independent risk factors for the presence of CLN metastasis, which allowed for selective pCLND in PTC. 27 Although some studies deny this association, in present study, CLN metastasis was detected in 75% of patients aged <45 years, while CLN metastasis was detected in only 40% of patients aged ≥45 years. 28 This difference was statistically significant (P=0.000) which in line with other studies.…”

Section: Discussioncontrasting

confidence: 57%

“…33 However, the size cutoffs differed in those studies but Suman et al, reported that larger tumors (tumor size >2cm) were significantly associated with CLN metastasis. 27 Ito et al reported that PTC of >2cm was the strongest independent risk factor for both microscopic central and lateral LN metastasis. 34 The presence of LN metastasis has been recorded to be 2-6 fold higher in patients with tumors of >4cm in comparison with smaller tumors.…”

Section: Discussionmentioning

confidence: 99%

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Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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INTRODUCTIONPTC is the most common well differentiated thyroid carcinoma (WDTC) and is considered a relatively indolent tumor.1 This relatively benign Behavior has led to a concept that CLND would not affect survival rates.2 Despite this, regional lymph node (LN) metastases are frequent in PTC occurring in 20% to 90% of patients. 3The pattern of LN metastasis takes place in a sequential manner; involving the central compartment (level VI) first with a frequency reaching 90% including micrometastases, followed by the ipsilateral lateral compartment and then the contralateral lateral compartment and the mediastinal LN. 4,5 Although there is consensus of block node dissection in node positive patients there is controversy about the benefits of elective CLND in N0 PTC. 6 Patients have a ABSTRACTBackground: Papillary thyroid carcinoma (PTC) is one of the commonest thyroid cancers. While there is consensus of block node dissection in nodal positive patients, there is controversy in dealing with nodal negative patients regarding the need of block node dissection. We aimed to evaluate prophylactic central lymph node dissection (pCLND) versus conservative management in PTC with N0 neck. Methods:This was a prospective randomized study conducted at General Surgery Department, Sohag University Hospital, from August 2013 to September 2017. It included fifty-five patients diagnosed to have PTC with N0 neck randomly divided into two groups; (Group A) included 25 patients who underwent total thyroidectomy (TT) alone and (Group B) included 30 patients who underwent TT with pCLND. We compared both groups regarding the operative and post-operative outcomes.Results: There was temporary hypoparathyroidism with an incidence of 12% for Group A and 23% for Group B (P=0.01). Permanent hypocalcemia occurred in 1 patient in each group (P=0.75). Unilateral recurrent laryngeal nerve (RLN) temporary palsy occurred in 10% for Group B patients and in 8% for Group A patients, (P=0.46). Node metastases were observed in 43% in group B upstaging the disease. Both univariate and multivariate analyses showed that CLN metastasis was significantly associated with age <45, male gender, tumor size >2.0cm, bilaterality, and multifocality. Locoregional recurrence was observed in 4% of patients in group A and in 0% in B.Conclusions: TT+pCLND is a safe treatment in patients with N0 PTC and it can be done without a high complication rate and without recurrence compared to TT without CLND.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Ali

Abdelhameed

2018

Int Surg J

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“…However, some authors have argued its application in cN0 PTMC because of the high prevalence of CLNM 25,27,35,51. The removal of the occult nodes in the central compartment may confirm the status of the central lymph node for predicting LLNM and guiding treatment, with the aim of reducing the disease persistence 52–55. Although CLNM was not significantly associated with prognosis according to survival analysis, from the viewpoint of the radical treatment of tumors, prophylactic CLND must be considered in PTMC patients who present with high-risk factors.…”

Section: Discussionmentioning

confidence: 99%

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

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“…However, in a study of 47,902 patients younger than 45 years with PTC, Adam et al [17] reported that the presence and number of lymph node metastases were associated with compromised survival. Suman et al [27] reported that ages younger than 45 years were an independent predictor of the presence of CLNM, which allowed for selective pCND in PTC. However, similar to most previous studies, this study included both CPTC and PTMC.…”

Section: Discussionmentioning

confidence: 99%

“…Jiang et al [30] reported that tumor size >1.5 cm was associated with increased incidence of CLNM in patients with cN 0 PTC. Suman et al [27] reported that larger tumors (tumor size >2 cm) were significantly associated with CLNM. In the present study, CLNM was more frequent in patients with tumor size >2 cm (64 of 83 cases, 77.1%), compared to patients with tumor size ≤2 cm (56 of 107 cases, 52.3%) ( P = 0.009).…”

Section: Discussionmentioning

confidence: 99%

To Identify Predictors of Central Lymph Node Metastasis in Patients with Clinically Node-Negative Conventional Papillary Thyroid Carcinoma

Yuan

Zhao

et al. 2016

International Journal of Endocrinology

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Objective. The aim of this study was to identify the risk factors associated with central lymph node metastasis (CLNM) in patients with clinically node-negative conventional papillary thyroid carcinoma (cN0 CPTC). Methods. A total of 190 cN0 CPTC patients who underwent thyroidectomy with prophylactic central neck dissection (pCND) in the Department of General Surgery at Guangdong General Hospital between March 2014 and December 2015 were assessed retrospectively. The relations of CLNM with clinicopathologic characteristics of cN0 CPTC were analyzed by univariate and multivariate logistic regression. Results. The incidence of CLNM in patients with cN0 CPTC was 63.2% (120 of 190 cases). Univariate analysis showed that age <45 years (P = 0.000), tumor size >2 cm (P = 0.009), multifocality (P = 0.001), and bilaterality (P = 0.000) were significantly associated with the increased incidence of CLNM in cN0 CPTC. No significant correlations were found between CLNM and other variables such as gender (P = 0.150), capsular invasion (P = 0.973), extrathyroidal invasion (P = 0.616), and lymphadenectomy (P = 0.062). Multivariate logistic regression analysis revealed that age <45 years (P = 0.000), tumor size >2 cm (P = 0.025), and bilaterality (P = 0.000) were independent risk factors of CLNM in patients with cN0 CPTC. Conclusions. Metastatic disease to central compartment lymph nodes is prevalent in patients with cN0 CPTC. Age <45 years, tumor size >2 cm, and bilaterality are independent risk factors of CLNM, which allow for selective CND in patients with cN0 CPTC.

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Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study

Cited by 44 publications

References 21 publications

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Papillary thyroid carcinoma, evaluation of prophylactic central compartment’s dissection versus conservative management: a prospective study

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

To Identify Predictors of Central Lymph Node Metastasis in Patients with Clinically Node-Negative Conventional Papillary Thyroid Carcinoma

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