Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer
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In papillary thyroid cancer, the role of lymph node dissection remains controversial, and staging systems consider metastatic lymph nodes as a binary entity. The purpose of this study was to determine a threshold lymph node ratio (LNR) that impacted disease-specific mortality (DSM).
We utilized the surveillance, epidemiology, and end results (SEER) database to analyze adult patients who underwent thyroidectomy with lymph node dissection. A LNR (metastatic lymph nodes to total lymph nodes) was calculated after eliminating patients with less than three nodes collected. Kaplan–Meier estimates for DSM were plotted for LNRs and compared by the log rank test. The Cox proportional hazards model was used to evaluate LNR with other known clinical and pathologic determinants of prognosis.
A total of 10,955 cases contained data on lymph nodes. Median follow-up time was 25 months (range 0–59 months), and the mean LNR was 0.28 ± 0.37. After comparing Kaplan–Meier survival estimates and overall DSM rates, we found that a LNR ≥0.42 best divided those with lymph node metastasis based on DSM (p < 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (p < 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68–11.18, p < 0.01).
LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.
- Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–2167. CrossRef
- Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A national cancer database report on 53,856 cases of thyroid carcinoma treated in the US, 1985–1995. Cancer. 1998;83:2638–2648. CrossRef
- Grubbs EG, Evans DB. Role of lymph node dissection in primary surgery for thyroid cancer. J Natl Compr Canc Netw. 2007;5:623–630.
- Noguchi S, Noguchi A, Murakami N. Papillary carcinoma of the thyroid: developing pattern of metastasis. Cancer. 1970;26:1053–1060.
- Qubain SW, Nakano S, Baba M, Takao S, Aikou T. Distribution of lymph node micrometastasis in pN0 well-differentiated thyroid carcinoma. Surgery. 2002;131:249–256. CrossRef
- Arturi F, Russo D, Giuffrida D, Ippolito A, Perrotti N, Vigneri R, et al. Early diagnosis by genetic analysis of differentiated thyroid cancer metastases in small lymph nodes. J Clin Endocrinol. 1997;82:1638–1641. CrossRef
- Wada N, Suganuma N, Nakayama H, Masudo K, Rino Y, Masuda M, et al. Microscopic regional lymph node status in papillary thyroid carcinoma with and without lymphadenopathy and its relation to outcomes. Langenbecks Arch Surg. 2007;392:417–422. CrossRef
- Mazzaferri EL, Young RL, Oertel JE, Kemmerer WT, Page CP. Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine. 1977;56:171–196. CrossRef
- Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71:731–734.
- Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144:1070–1078. CrossRef
- Hughes DT, Doherty GM. Central neck dissection for papillary thyroid cancer. Cancer Control. 2011;18:83–88.
- Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148:1100–1106.
- Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009;19:683–689. CrossRef
- Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1988;104:947–953.
- Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging atlas. New York: Springer; 2010.
- Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102:1088–1095.
- Byar DP, Green SB, Dor P, Williams D, Colon J, van Gilse H, et al. A prognostic index for thyroid carcinoma: a study of the EORTC Thyroid Cancer Cooperative Group. Eur J Cancer. 1979;15:1033–1041.
- Sherman SI, Brierley JD, Sperling M, Ain KB, Bigos T, Cooper DS, et al. Prospective multicenter study of thyroid carcinoma treatment. Cancer. 1988;83:1012–1021.
- Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–428. CrossRef
- Mocellin S, Pasquali S, Rossi CR, Nitti D. Validation of the prognostic value of lymph node ratio in patients with cutaneous melanoma: a population-based study of 8,177 cases. Surgery. 2011;150:83–90. CrossRef
- Schiffman SC, McMasters KM, Scoggins CR, Martin RC, Chagpar AB. Lymph node ratio: a proposed refinement of current axillary staging in breast cancer patients. J Am Coll Surg. 2011;213:45–53. CrossRef
- Beal SH, Chen SL, Schneider PD, Martinez SR. An evaluation of lymph node yield and lymph node ratio in well-differentiated thyroid carcinoma. Am Surg. 2010;76:28–32.
- Lang BH, Wong KP, Wan KY, Lo CY. Significance of metastatic lymph node ratio on stimulated thyroglobulin levels in papillary thyroid carcinoma after prophylactic unilateral central neck dissection. Ann Surg Oncol. 2012;19:1257–1263. CrossRef
- Poehls JL, Chen H, Sippel RS. Preoperative ultrasonography findings predict the need for repeated surgery in papillary thyroid cancer. Endocr Pract. 2012;18:403–409. CrossRef
- Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer
Annals of Surgical Oncology
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