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Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome

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Abstract

Purpose

Papillary thyroid carcinoma (PTC), the most common thyroid cancer histotype, has a good prognosis even when spread to the neck lymph node (LN). The prognostic role of LN metastases’ location is still controversial. The aim of the present study was to evaluate the clinical relevance of the number and location of LN metastases at presentation in PTCs.

Methods

This retrospective study included a consecutive series of 1653 PTC patients followed for a mean period of 5.9 years in a referral thyroid cancer clinic. All patients have undergone thyroidectomy with the dissection of at least six LNs. According to the LN status, patients were subdivided into 569 N0 (34.4%), 644 N1a (39.0%, central compartment) and 440 N1b (26.6%, latero-cervical compartment).

Results

Age at diagnosis was significantly lower in N1b (39.8, IQR 30.7–51.6) and N1a (40.1, IQR 31.3–50.1) than in N0 (44.7, IQR 36.6–55.0 yrs). The male gender was more prevalent in N1b than in N1a and N0 (F/M = 1.9/1, 4.0/1 and 5.5/1, respectively). Persistent/recurrent disease at last control was significantly more frequent in N1b (29.8%) than in N1a (14.3%), and in N1a than in N0 (4.2%) (p < 0.01 for all). Also, distant metastases were significantly (p < 0.001) more frequent in N1b (14.1%) than in N1a (4.3%) and N0 (1.6%). LN metastases’ number (>5) was a significant risk factor for persistent/recurrent disease only for N1a patients.

Conclusions

These data indicate that persistent/recurrent disease and distant metastases are significantly more frequent in patients with latero-cervical LN (N1b) metastases and that the LN location should be used for a better postsurgical risk stratification.

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Acknowledgements

This work was supported in part by a Grant from the Associazione Italiana per la Ricerca sul Cancro (AIRC, Milan, Italy) to R.V.

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Author notes

  1. R. Vigneri and G. Pellegriti are equally contributed to this paper.

Authors and Affiliations

  1. Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy

    G. Sapuppo, M. Tavarelli, S. Squatrito, R. Vigneri & G. Pellegriti

  2. Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    F. Palermo

  3. Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    M. Russo

  4. Department of Surgical Oncology, Garibaldi-Nesima Medical Center, Catania, Italy

    R. Masucci

  5. Humanitas, Catania Oncology Center, Catania, Italy

    R. Vigneri

  6. Institute of Biostructures and Bioimages, National Research Council, CNR, Catania, Italy

    R. Vigneri

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  1. G. Sapuppo
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Correspondence to G. Pellegriti.

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All procedures involving human participants were in accordance with the ethical standards of institutional research committee and with the Helsinki declaration as revised in 2013.

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Sapuppo, G., Palermo, F., Russo, M. et al. Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome. J Endocrinol Invest 40, 1355–1363 (2017). https://doi.org/10.1007/s40618-017-0714-y

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