Clinical risk factors associated with cervical lymph node recurrence in papillary thyroid carcinoma.

BACKGROUND Recurrence of regional cervical lymph nodes in patients with papillary thyroid carcinoma (PTC) is not uncommon, and is an important factor affecting the quality of life. The aims of this study are to investigate the risk factors that are associated with regional lymph node recurrence by comparing a group of patients with regional lymph node recurrence with a group without lymph node recurrence, and to analyze the clinical characteristics of recurrent regional lymph nodes in PTC. METHODS A retrospective analysis was performed on 189 patients who underwent surgery for PTC. By comparing a group with recurrent cervical lymph nodes (n = 33) with a group without recurrent cervical lymph nodes (n = 156), the risk factors for cervical lymph node recurrence were investigated and the clinical characteristics of recurrent cervical lymph nodes were analyzed. RESULTS Tumor size >2 cm, presence of extrathyroid tumor spread, high T stage, and presence of lymph node metastasis were associated with regional lymph node recurrence in univariate analysis (p < 0.05). Among them, only the N stage was significantly associated with regional recurrence in multivariate analysis (p < 0.05). The disease-free survival period was shorter in the lymph node metastasis-positive group, and the 10-year disease-free survival rate was 77.8% in the lymph node metastasis-negative group and 57.9% in the lymph node metastasis-positive group (p < 0.05). Among 130 patients without lymph node metastasis, regional recurrence occurred in 13 patients (10%), and the frequent levels of regional recurrence were levels II-IV of ipsilateral neck. In the patients with lymph node metastasis, the frequent levels were levels IV-VI of ipsilateral side and level II of the contralateral side. CONCLUSION Considering the low incidence of regional lymph node recurrence and the levels with frequent regional recurrence in patients without lymph node metastasis, elective neck dissection in all cases of total thyroidectomy may be immoderate. However, if any risk factors for regional recurrence, including large tumor size, presence of extrathyroid spread, high T stage, and presence of lymph node metastasis, are detected by preoperative and intraoperative evaluation, a systematic compartment-oriented lymphadenectomy should be considered because of the high possibility of regional recurrence.

[1]  I. Sugitani,et al.  A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. , 2004, Surgery.

[2]  Piero Nicolai,et al.  The spinal accessory nerve in head and neck surgery , 2007, Current opinion in otolaryngology & head and neck surgery.

[3]  D. Steward,et al.  The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. , 2009, Thyroid : official journal of the American Thyroid Association.

[4]  I. Sugitani,et al.  Prospective Outcomes of Selective Lymph Node Dissection for Papillary Thyroid Carcinoma Based on Preoperative Ultrasonography , 2008, World Journal of Surgery.

[5]  E. Lee,et al.  Extent of Routine Central Lymph Node Dissection With Small Papillary Thyroid Carcinoma , 2007, World Journal of Surgery.

[6]  E. Baudin,et al.  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. , 2005, The Journal of clinical endocrinology and metabolism.

[7]  J. Pasieka,et al.  Differentiated thyroid carcinoma in children and adolescents , 1992, World Journal of Surgery.

[8]  E. Kaplan,et al.  Natural history, treatment, and course of papillary thyroid carcinoma. , 1990, The Journal of clinical endocrinology and metabolism.

[9]  J. Shah,et al.  Impact of lymph node metastasis in differentiated carcinoma of the thyroid: A matched‐pair analysis , 1996, Head & neck.

[10]  H. Röher,et al.  Incidence of Regional Recurrence Guiding Radicality in Differentiated Thyroid Carcinoma , 1996, World Journal of Surgery.

[11]  J. Shah,et al.  Risk group stratification and prognostic factors in papillary carcinoma of thyroid , 1996, Annals of Surgical Oncology.

[12]  B. Cady,et al.  An expanded view of risk-group definition in differentiated thyroid carcinoma. , 1988, Surgery.

[13]  E. Pearce,et al.  Papillary thyroid microcarcinoma outcomes and implications for treatment. , 2004, The Journal of clinical endocrinology and metabolism.

[14]  J. Shah,et al.  Low-risk differentiated thyroid cancer: The need for selective treatment , 1997, Annals of Surgical Oncology.

[15]  J. Attie.  Modified neck dissection in treatment of thyroid cancer: a safe procedure. , 1988, European journal of cancer & clinical oncology.

[16]  Su He Wang,et al.  No apparent damage in the thyroid of transgenic mice expressing antiapoptotic FLIP. , 2006, Thyroid : official journal of the American Thyroid Association.

[17]  K. Kaczirek,et al.  Prognostic factors of papillary and follicular thyroid cancer: differences in an iodine-replete endemic goiter region. , 2004, Endocrine-related cancer.

[18]  S. Noguchi,et al.  Papillary carcinoma of the thyroid I. Developing pattern of metastasis , 1970, Cancer.

[19]  R. Udelsman,et al.  The current management of thyroid cancer. , 1999, Advances in surgery.

[20]  S. Jhiang,et al.  Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. , 1994, The American journal of medicine.

[21]  H. Wanebo,et al.  Prognostic factors and management considerations in patients with cervical metastases of thyroid cancer. , 1992, American journal of surgery.

[22]  H. Hundeshagen,et al.  Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer , 1994, World Journal of Surgery.

[23]  S. Noguchi,et al.  Papillary carcinoma of the thyroid II. Value of prophylactic lymph node excision , 1970, Cancer.

[24]  D. Steward,et al.  Sonographically‐Directed Neck Dissection for Recurrent Thyroid Carcinoma , 2008, The Laryngoscope.

[25]  E. Bergstralh,et al.  Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. , 1993, Surgery.

[26]  L. Woolner,et al.  Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome. , 1986, Mayo Clinic proceedings.

[27]  L. Kowalski,et al.  Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. , 2004, American journal of otolaryngology.