World Journal of Surgery

, Volume 18, Issue 4, pp 559–567 | Cite as

Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer

  • Georg F. W. Scheumann
  • Oliver Gimm
  • Gerd Wegener
  • H. Hundeshagen
  • Henning Dralle
International Association of Endocrine Surgeons—Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993

Abstract

We studied the records of 342 patients with papillary thyroid carcinoma out of a total of 728 thyroid cancer patients treated at the Medical School of Hannover (MHH) from 1972 through 1992. The comprehensive data-abstracting forms were designed, and the acquired information was coded, stored, maintained, and evaluated by the Clinical Cancer Registry of the MHH. A total of 160 patients (46.8%) initially had lymph node metastases (N1 status). The N status significantly influenced recurrence (p<0.00001) and survival (p<0.00001). Excluding other risk factors developed by univariate and multivariate analysis, such as high age (age >45 years, p<0.001), tumor invasion (T4 tumor, p<0.005), and distant metastases (M1, p<0.001), lymph node metastases remained an independent, highly significant prognostic marker for more aggressive papillary thyroid cancer. N1 status did not influence survival of patients with T4 tumor but did influence those with T1–T3 status (p<0.001). The influence of N1 status remained significant in patients older (p<0.001) and younger (p<0.05) than 45 years of age. Systematic compartmentoriented dissection of lymph node metastases improved survival (p<0.005, T1–T3) and recurrence (p<0.00001, T1–T3) especially in patients with T1–T3 tumors. In conclusion, lymph node metastases with a significant incidence at a young age and male sex had a substantial effect on survival and recurrence especially in those with tumor status T1–T3. Systematic compartment-oriented dissection of the lymph node metastases results in better survival and a lower recurrence rate.

Résumé

Nous avons étudié les dossiers de 342 patients ayant un cancer papillaire appartenant à une série de 728 patients ayant un cancer de la thyroïde traités á l'Ecole de Médecine de Hanovre (EMH) entre 1972 et 1992. Les réponses d'un questionnaire standardisé ont été traités par l'informatiques par le Registre Clinique des Cancers de l'EMH. Cent soixante patients (46.8%) avaient des métastases lymphatiques initiales (N1). Le stade N+ou-a significativement influencé la récidive (p<0.00001) et la survie (p<0.00001). En excluant les autres facteurs de risque par l'analyse mono et multifactorielle, l'âge>45 ans (p<0.001), l'invasion tumorale (T4) (p<0.005) et les métastases à distance (M1) (p<0.001) ont été retenus comme facteurs pronostiques indépendants et sont considérés comme indicatifs d'un cancer invasif. Le stade N1 des cancers a influencé la survie des patients ayant une tumeur T1–3 mais pas ceux ayant une tumeur T4 (p<0.001).

L'influence des stades N1 est significative chez les patients>45 ans (p<0.001) ainsi que ceux<45 ans (p<0.05). Le curage orienté par la localisation compartementale de la tumeur a amélioré la survie (p<0.005) et abaissé le taux de récidive (p<0.00001) surtout chez les patients ayant une tumeur T1–3. En conclusion, la présence de métastases lymphatiques, un âge<45 ans, et le sexe mâle sont des facteurs pronostiques de survie et de récidive chez le patients ayant une tumeur T1–3. Le curage orienté par la localisation compartementale améliore le taux de survie et abaisse le taux de récidives.

Translator's notes; This summary containes incomplete information. “LMN” is not defined.

Resumen

Hemos estudiado las historias de 342 pacientes con carcinoma papilar dentro de un total de 728 pacientes con cáncer de la glándula tiroides tratados en la Escuela de Medicina de Hannover, Alemania, desde 1972 hasta finales de 1992.

Se diseñaron formatos para la codificación de la información, la cual fue almacenada, mantenida y evaluada por el registro clínico de cáncer de la Escuela de Medicina de Hannover.

En el grupo de pacientes, 160 (46.8%), presentaban metástasis ganglionares en su presentaciòn inicial (estado N1). El estado N exhibió una significativa influencia sobre la recidiva (p≪0,0001) y la sobrevida (p≪0,0001). Al excluir otros factores adicionales de riesgo identificados mediante análisis univariable y multivariable, tales como edad (mayores de 45 años, p≪0,001), invasión tumoral (tumor T4, p≪0.005) y metástasis distantes (M1, p≪0,001), las metástasis ganglionares se mantuvieron como un marcador independiente y altamente significativo de comportamiento agresivo del cáncer tiroideo. El estado N1 no tuvo influencia sobre la sobrevida de pacientes con tumor T4 sino con el estado T1–T3 (p≪0,001).

La influencia del estado N1 se mantuvo significativa en los pacientes de mayor edad (p≪0,001) y los menores de 45 años (p<0,05). La disección sistemática y de tipo compartimental de las metástasis ganglionares mejoró la sobrevida (p≪0,005, T1–T3) y la recidiva (p≪0,00001, T1–T3), especialmente en pacientes con tumor T1–T3. En conclusión, las metástasis ganglionares con incidencia significativa en la edad joven y en el sexo masculino exhibieron una influencia sustancial en lo pertinente a sobrevida y recidíva, especialmente en los pacientes con tumor T1–T3. La disección sistemática de tipo compartimental de las metástasis ganglionares resulta en mejor tasa de sobrevida y menor tasa de recidiva.

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Copyright information

© Société Internationale de Chirurgie 1994

Authors and Affiliations

  • Georg F. W. Scheumann
    • 1
  • Oliver Gimm
    • 1
  • Gerd Wegener
    • 2
  • H. Hundeshagen
    • 3
  • Henning Dralle
    • 1
  1. 1.Klinik für Abdominal und TransplantationschirurgieMedical School HannoverHannoverGermany
  2. 2.Klinisches Krebsregister (Niedersachsen)Medical School HannoverHannoverGermany
  3. 3.Klinik für Nuklearmedizin und spezielle BiophysikMedical School HannoverHannoverGermany

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