Risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer

Zhao, Hengqiang; Huang, Tao; Li, Hehe

doi:10.1016/j.surg.2019.01.025

Cited by 102 publications

(102 citation statements)

References 23 publications

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“…4,9,10 The incidence rate of skip metastasis ranges from 6.8% to 27.8% in PTC with LLNM. 15,20 In our study, skip metastasis was present in 62 out of 256 patients with LLNM (24.2%), which is a higher rate than in most other studies. The reason may be that all patients enrolled had PTMC, which is considered a risk factor for skip metastasis.…”

Section: Discussioncontrasting

confidence: 44%

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<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Song¹,

Yan²,

Qiu³

et al. 2020

CMAR

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To investigate the risk factors for cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). Patients and Methods: In total, 3686 patients with PTMC who underwent initial surgery in Shanghai Jiao Tong University affiliated Sixth People's Hospital from January 2010 to December 2019 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify risk factors associated with cervical LNM.

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Section: Discussioncontrasting

confidence: 44%

“…The reason may be that all patients enrolled had PTMC, which is considered a risk factor for skip metastasis. 20 Furthermore, our results demonstrated that roughly one-third (84/248) of patients with more than three central LNs had LLNM. For such patients, we recommend close observation and strict evaluation in the perioperative period.…”

Section: Discussionmentioning

confidence: 50%

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Song¹,

Yan²,

Qiu³

et al. 2020

CMAR

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“…An additional consideration is that pCLNM can affect lateral LN recurrence. Several previous studies have revealed that pCLNM is associated with lateral LN metastasis [ 37 , 48 , 49 , 50 , 51 ]. These studies indicated the possibility of occult lateral LN metastasis in TC with pCLNM.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, active and frequent follow-up is thought to be sufficient for patients with pCLNM. In addition, lateral LN metastasis without pCLNM, so-called skip metastasis, was reported in 6.8–27.8% of PTC patients [ 48 , 53 , 54 , 55 , 56 , 57 ]. Combining this finding with our results, we carefully question the effectiveness of prophylactic CCND for cN0 PTMC; however, additional prospective randomized studies will be needed in the future.…”

Section: Discussionmentioning

confidence: 99%

Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up

Choi

Kim

Lee

et al. 2020

Cancers

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The necessity of completion total thyroidectomy in patients with papillary thyroid microcarcinoma (PTMC) and pathological central lymph node metastasis (pCLNM) who underwent thyroid lobectomy with central compartment neck dissection (CCND) is unclear. We determined the necessity of completion total thyroidectomy by retrospectively comparing the prognosis according to the presence of pCLNM during a long-term follow-up. We enrolled 876 patients with PTMC who underwent thyroid lobectomy with prophylactic CCND from January 1986 to December 2009. Patients were divided according to central lymph node (CLN) metastasis: 165 (18.8%) and 711 (81.2%) in the CLN-positive and CLN-negative groups, respectively. Medical records were reviewed retrospectively, and clinicopathologic characteristics and recurrence rates were analyzed. The CLN-positive group was associated with male sex (p = 0.001), larger tumor size (p < 0.001), and more microscopic capsular invasion (p < 0.001) compared with the CLN-negative group. There was no significant difference between the two groups’ recurrence (p = 0.133) or disease-free (p = 0.065) survival rates. Univariate and multivariate analyses showed no factors associated with tumor recurrence except male sex (hazard ratio = 3.043, confidence interval 1.117–8.288, p = 0.030). Patients who were diagnosed with pCLNM after undergoing thyroid lobectomy with prophylactic CCND do not require completion total thyroidectomy; however, frequent follow-up is necessary for patients with PTMC and pCLNM.

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“…Some patients develop lateral LNM without the involvement of central LNM via histopathological diagnosis, which is referred to as "skip metastasis" [6,9,10]. The rate of skip metastasis in PTC ranged from 1.6% to 21.8% [11][12][13]. The significance of skip metastasis in patients with PTC is still unclear.…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict skip metastasis in papillary thyroid cancer

Ouyang

Wang²

2020

Preprint

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Background Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients. Patients and Methods A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 were enrolled in our hospital, Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internal validated. Results The incidence of skip metastasis was 11.9% (45/378). Primary tumor size ≦1cm(OR=2.703, 95%CI,1342-5.464; P =0.005 ), Age(OR=1.051, 95%CI, 1.017-1.805, P =0.005), Primary tumor location in the upper portion(OR=6.799, 95%CI, 2.710-17.060, P < 0.001)were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. With an area under the curve (AUC) of 0.806 (95%CI,0.736-0.876) and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66, Decision curve analysis revealed that nomogram was clinically useful. Conclusion Based on the risk factors of skip metastasis and established a high-performance nomogram, which can provide an individual risk assessment and guide treatment decisions for patients.

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Risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer

Cited by 102 publications

References 23 publications

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

<p>Clinical Analysis of Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Study of 3686 Patients</p>

Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up

A nomogram to predict skip metastasis in papillary thyroid cancer

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