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

  • International Association of Endocrine Surgeons—Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993
  • Published:
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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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References

  1. Cady, B.: Lymph node metastases. Arch. Surg. 119:1067, 1984

    Google Scholar 

  2. Crucitti, F., Doglietto, G.B., Bellantone, R., et al.: Accurate specimen preparation and examination is mandatory to detect lymph nodes and avoiding understaging in colorectal cancer. J. Surg. Oncol. 51:153, 1992

    Google Scholar 

  3. Soga, J., Ohyama, S., Miyashita, K., et al.: A statistical evaluation of advancement in gastric cancer surgery with special reference to the significance of lymphadenectomy for cure. World J. Surg. 12:398, 1988

    Google Scholar 

  4. Harness, J.K., Thompson, N.W., McLeod, M.K., Pasieka, J.L., Fukuuchi, A.: Differentiated thyroid carcinoma in children and adolescents. World J. Surg. 16:547, 1992

    Google Scholar 

  5. McHenry, C.R., Rosen, I.B., Walfish, P.G.: Prospective management of nodal metastases in differentiated thyroid cancer. Am. J. Surg. 162:353, 1991

    Google Scholar 

  6. Simpson, W.J., McKinney, S.E., Carruthers, J.S., Gospodarowicz, M.K., Sutcliffe, S.B., Panzarella, T.: Papillary and follicular thyroid cancer: prognostic factors in 1578 patients. Am. J. Surg. 83:479, 1987

    Google Scholar 

  7. Block, M.A., Miller, J.M., Horn, R.C.: Significance of mediastinal lymph node metastases in carcinoma of the thyroid. Am. J. Surg. 123:702, 1972

    Google Scholar 

  8. Byar, D.P., Green, S.B., Dor, P., et al.: A prognostic index for thyroid carcinoma: a study of the E.O.R.T.C. thyroid cancer cooperative group. Eur. J. Cancer 15:1033, 1979

    Google Scholar 

  9. Noguchi, S., Murakami, N.: The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg. Clin. North Am. 67:251, 1987

    Google Scholar 

  10. Noguchi, S., Noguchi, A., Murakami, N.: Papillary carcinoma of the thyroid. I. Developing pattern of metastases. Cancer 26:1053, 1970

    Google Scholar 

  11. Noguchi, S., Noguchi, A., Murakami, N.: Papillary carcinoma of the thyroid. II. Value of prophylactic lymph node excision. Cancer 26:1061, 1970

    Google Scholar 

  12. Sellers, M., Beenken, S., Blankenship, A., et al.: Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am. J. Surg. 164:578, 1992

    Google Scholar 

  13. Hedinger, P., Williams, E.D., Sobin, L.H.: Histological Typing of Thyroid Tumors (2nd ed.) World Health Organization. New York, Springer-Verlag, 1988

    Google Scholar 

  14. Hermanek, P., Sobin, L.H.: TNM Classification of Malignant Tumors (4th ed.). Berlin, Springer-Verlag, 1987

    Google Scholar 

  15. Fisch, U.P., Sigel, M.E.: Cervical lymphatic system as visualized by lymphography. Ann Otol. Rhinol. Laryngol. 73:869, (1964)

    Google Scholar 

  16. Jackson, L., Wallace, S., Fabr, S.N., Parke, W.W., Toy, F.: Cervical lymphography. Laryngoscope 73:926, 1963

    Google Scholar 

  17. Dralle, H., Scheumann, G.F.W., Kotzerke, J., Brabant, E.G.: Surgical management of MEN 2. Recent Results Cancer Res. 125:167, 1992

    Google Scholar 

  18. Dralle, H., Damm, I., Scheuman, G.F.W., Kotzerke, J., Kupsche, E.: Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Jpn. J. Surg. 112:1994, 1993

    Google Scholar 

  19. Tisell, L.E., Hansson, G., Jansson, S., Salander, H.: Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma. Surgery 99:60, 1986

    Google Scholar 

  20. Cox, D.R., Oakes, D.: Analysis of Survival Time Data. London, Chapman & Hall, 1984

    Google Scholar 

  21. Dixon, W.J.: BMDP Statistical Software Manual (Vol. 2). Berkeley, University of California Press, 1990

    Google Scholar 

  22. Kalbfleisch, J.D., Prentice, R.L.: The Statistical Analyses of Survival Time Data, New York, Wiley, 1980

    Google Scholar 

  23. Kaplan, E.L., Meier, P.: Nonparametric estimation from incomplete observations. J. Am. Stat. Assoc. 53:457, 1958

    Google Scholar 

  24. Hay, I.D.: Papillary thyroid carcinoma. Endocrinol. Metab. Clin. North Am. 19:719, 1990

    Google Scholar 

  25. Mazzaferri, E.L.: Papillary thyroid carcinoma: factors influecing prognosis and current therapy. Semin. Oncol. 14:315, 1987

    Google Scholar 

  26. Mazzaferri, E.L., Young, R.L.: Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am. J. Med. 70:511, 1981

    Google Scholar 

  27. McConahey, W.M., Hay, I.D., Woolner, L.B., van Heerden, J.A., Taylor, W.F.: Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome. Mayo Clin. Proc. 61:978, 1986

    Google Scholar 

  28. Attie, J.N.: Modified neck dissection in treatment, of thyroid cancer: a safe procedure. Eur. J. Cancer Clin. Oncol. 24:315, 1988

    Google Scholar 

  29. DeGroot, L.J., Kaplan, E.L., McCormick, M., Straus, F.H.: Natural history, treatment, and course of papillary thyroid carcinoma. J. Clin. Endocrinol. Metab. 71:414, 1990

    Google Scholar 

  30. Cady, B.: Surgery of thyroid cancer. World J. Surg. 5:3, 1981

    Google Scholar 

  31. Harwood, J., Clark, O.H., Dunphy, J.E.: Significance of lymph node metastases in differentiated thyroid cancer. Am. J. Surg. 136:107, 1978

    Google Scholar 

  32. Ozaki, O., Ito, K., Kobayashi, K., Suzuki, A., Manabe, Y., Hosoda, Y.: Modified neck dissection for patients with non advanced, differentiated carcinoma of the thyroid. World J. Surg. 12:825, 1988

    Google Scholar 

  33. Noguchi, M., Kumaki, T., Taniya, T., Miyazaki, I.: Bilateral cervical lymph node metastases in well-differentiated thyroid cancer. Arch. Surg. 125:804, 1990

    Google Scholar 

  34. Noguchi, M., Kumaki, T., Taniya, T., et al.: Impact of neck dissection on survival in well-differentiated thyroid cancer: a multivariate analysis of 218 cases. Int. Surg. 75:220, 1990

    Google Scholar 

  35. Noguchi, M., Yamada, H., Ohta, N. et al.: Regional lymph node metastases in well-differentiated thyroid carcinoma. Int. Surg. 72:100, 1987

    Google Scholar 

  36. Cunningham, M.P., Duda, R.B., Recant, W., Chmiel, J.S., Sylvester, J., Fremgen, A.: Survival discriminant for differentiated thyroid cancer. Am. J. Surg 160:344, 1990

    Google Scholar 

  37. Vickery, A.L., Wang, C.A., Walker, A.M.: Treatment of intrathyroidal papillary carcinoma of the thyroid. Cancer 60:2587, 1987

    Google Scholar 

  38. Ballantyne, A.J.: Neck dissection for thyroid cancer. Semin. Surg. Oncol. 7:100, 1991

    Google Scholar 

  39. Hay, I.D., Grant, C.S., Taylor, W.F., McConahey, W.M.: Ipsilateral lobectomy versus bilateral resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 102:1088, 1987

    Google Scholar 

  40. Hamming, J.F., van de Velde, C.J., Delemare, J.F., van Slooten, E.A.: Preoperative diagnosis and treatment of metastasis to the regional lymph nodes in papillary carcinoma of the thyroid gland. Surg. Gynecol. Obstet. 169:107, 1989

    Google Scholar 

  41. Hoie, J., Stenwig, E., Brennhovd, I.O.: Surgery in papillary thyroid carcinoma: a review of 730 patients. J. Surg. Oncol. 37:147, 1988

    Google Scholar 

  42. Vassiloupou-Sellin, R., Klein, M.J., Smith, T.H., et al.: Pulmonary metastases in children and young adults with differentiated thyroid cancer. Cancer 71:1348, 1993

    Google Scholar 

  43. Wilson, S.M., Boch, G.E.: Carcinoma of the thyroid metastatic to the lymph nodes of the neck. Arch. Surg. 102:285, 1971

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Abdominal und Transplantationschirurgie, Medical School Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Georg F. W. Scheumann M.D., Oliver Gimm & Henning Dralle M.D.

  2. Klinisches Krebsregister (Niedersachsen), Medical School Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    Gerd Wegener

  3. Klinik für Nuklearmedizin und spezielle Biophysik, Medical School Hannover, Konstanty-Gutschow-Strasse 8, 30625, Hannover, Germany

    H. Hundeshagen M.D.

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  1. Georg F. W. Scheumann M.D.
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  5. Henning Dralle M.D.
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Scheumann, G.F.W., Gimm, O., Wegener, G. et al. Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J. Surg. 18, 559–567 (1994). https://doi.org/10.1007/BF00353765

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