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Risk Factors for Recurrence to the Lymph Node in Papillary Thyroid Carcinoma Patients without Preoperatively Detectable Lateral Node Metastasis: Validity of Prophylactic Modified Radical Neck Dissection

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Abstract

Background

Although papillary carcinoma usually shows mild characteristics, it metastasizes and shows recurrence to the lymph node in high incidences. Of the two representative lymph node compartments to which papillary carcinoma metastasizes, the central compartment can be routinely dissected via the surgical incision made for thyroidectomy. However, the routine application of prophylactic lateral node dissection (modified radical neck dissection [MND]) remains controversial. In this study, we investigated risk factors for lymph node recurrence of papillary carcinoma to determine the appropriate application of prophylactic MND.

Methods

We investigated risk factors for lymph node recurrence in 1,231 patients without preoperatively detectable lateral node metastasis who underwent thyroidectomy, central node dissection, and prophylactic MND for papillary carcinoma between 1987 and 1995.

Results

The incidence of lateral node metastasis and the number of metastatic lateral nodes significantly increased with carcinoma size. The lymph node disease-free survival (LN-DFS) was also significantly worse in carcinoma with a maximal diameter greater than 3 cm. Massive extrathyroid extension, male gender, and age 55 years or older also reflected a poorer LN-DFS. The 10-year LN-DFS rates of patients with carcinoma having two and three or four of these features were low at 88.5% and 64.7%, respectively, although the rates of those with carcinoma having no or only one characteristic were better than 95%.

Conclusions

Prophylactic MND is recommended for cases of papillary carcinoma demonstrating two or more of the following four characteristics; male gender, age 55 years or older, maximal tumor diameter larger than 3 cm, and massive extrathyroid extension.

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References

  1. Noguchi S, Noguchi A, Murakami N (1970) Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer 26:1053–1060

    Article  PubMed  CAS  Google Scholar 

  2. Ito Y, Miyauchi A, Jikuzono T, et al. (2007) Risk factors contributing to a poor prognosis of papillary thyroid carcinoma; validity of UICC/AJCC TNM classification and stage grouping. World J Surg 31:838–848

    Article  PubMed  Google Scholar 

  3. Kouvaraki MA, Shapiro SE, Bruno MS, et al. (2003) Role of preoperative ultraosonography in the surgical management of patients with thyroid cancer. Surgery 134:946–955

    Article  PubMed  Google Scholar 

  4. Stulak JM, Grant CS, Farley DR, et al. (2006) Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid carcinoma. Arch Surg 141:489–496

    Article  PubMed  Google Scholar 

  5. Dralle H, Gimm O (1996) Lymphadenektomie beim schilddrusencarcinom. Chirurg 67:788–806 (in German)

    Article  PubMed  CAS  Google Scholar 

  6. Martenson H, Terins J (1985) Recurrent laryngeal nerve palsy in thyroid gland surgery related to operations and nerves at risk. Arch Surg 120:475–482

    Google Scholar 

  7. Scheumann GF, Seeliger H, Musholt TF, et al. (1996) Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg 162:677–684

    PubMed  CAS  Google Scholar 

  8. McConahey WM, Hay ID, Woolner LB, et al. (1986) Papillary thyroid cancer treated at Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy and outcome. Mayo Clin Proc 61:978–996

    PubMed  CAS  Google Scholar 

  9. DeGroot LJ, Kaplan EL, McCormick M, et al. (1990) Natural history, treatment, and course of papillary thyroid carcinomas. J Clin Endocrinol Metab 71:414–424

    Article  PubMed  CAS  Google Scholar 

  10. Mazzaferri EL, Young RL (1981) Papillary thyroid carcinoma: a 10 year follow-up report of the impact of therapy in 576 patients. Am J Med 70:511–518

    Article  PubMed  CAS  Google Scholar 

  11. Cunningham MP, Duda RB, Recant W, et al. (1990) Survival discriminants for differentiated thyroid cancer. Am J Surg 160:344–347

    Article  PubMed  CAS  Google Scholar 

  12. Bacourt F, Asselain B, Savoie JC, et al. (1986) Multivariate study of prognostic factors in differentiated thyroid carcinoma and re-evaluation of the important of age. Br J Surg 73:274–277

    Article  PubMed  CAS  Google Scholar 

  13. Grabe SKG, Hay ID (1996) Thyroid cancer nodal metastasis. Surg Oncol Clin North Am 5:43–63

    Google Scholar 

  14. Sellers M, Beenken S, Blankenship A, et al. (1992) Prognostic significance of cervical lymph node metastases in differentiated thyroid cancer. Am J Surg 164:578–581

    Article  PubMed  CAS  Google Scholar 

  15. Franssila KO (1975) Prognosis in thyroid carcinoma. Cancer 36:1138–1146

    Article  PubMed  CAS  Google Scholar 

  16. Lungdren CI, Hall P, Dickman PW, et al. (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma. A population-based, nested case-control study. Cancer 106:524–531

    Article  Google Scholar 

  17. Simon D, Goretzki PE, Witte J, et al. (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866

    Article  PubMed  CAS  Google Scholar 

  18. Noguchi S, Murakami N, Yamashita H, et al. (1998) Papillary thyroid carcinoma. Modified radical neck dissection improves prognosis. Arch Surg 133:276–280

    Article  PubMed  CAS  Google Scholar 

  19. Sakamoto A, Kasai N, Sugano H (1983) Poorly differentiated carcinoma of the thyroid. A clinicopathologic entity for a high-risk group of papillary and follicular carcinomas. Cancer 52:1849–1855

    Article  PubMed  CAS  Google Scholar 

  20. DeLellis RA, Lloyd RV, Heitz PU, et al. (2004) WHO Classification of Tumours, Pathology and Genetics of Tumours of Endocrine Organs. IARC Press, Lyon, France, pp 73–76

    Google Scholar 

  21. Sobin LH, Wittekind Ch (2002) eds. UICC; TNM classification of malignant tumors, 6th Edition. New York, Wiley-Liss

    Google Scholar 

  22. Antonelli A, Miccoli P, Ferdeghini M, et al. (1995) Role of neck ultrsonography in follow-up of patients operated on for different thyroid cancer. Thyroid 5:25–29

    Article  PubMed  CAS  Google Scholar 

  23. Uruno T, Miyauchi A, Shimizu K, et al. (2005) Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29:493–495

    Google Scholar 

  24. Miyauchi A, Matsusaka K, Kihara M, et al. (1998) The role of ansa-to-recurrent-laryngeal nerve anastomosis in operations for thyroid cancer. Eur J Surg 164:927–933

    Article  PubMed  CAS  Google Scholar 

  25. Miyauchi A, Yokozawa T, Kobayashi K, et al. (2001) Opposite ansa cervicalis to recurrent laryngeal nerve anastomosis to restore phonation in patients with advanced thyroid cancer. Eur J Surg 167:540–541

    Article  PubMed  CAS  Google Scholar 

  26. Mazzaferri EL, Young RL, Oertel JE, et al. (1977) Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine 56:171–195

    Article  PubMed  CAS  Google Scholar 

  27. Ito Y, Tomoda C, Uruno T, et al. (2004) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28:1115–1121

    Article  PubMed  Google Scholar 

  28. Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits and risks. World J Surg 31:905–915

  29. Ito Y, Tomoda C, Uruno T, et al. (2004) Preoperative ultrasonographic examination for lymph node metastasis is useful when designing lymph node dissection for papillary microcarcinoma. World J Surg 28:498–501

    Article  PubMed  Google Scholar 

  30. Simon D, Goretzki PE, Witte J, et al. (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866

    Article  PubMed  CAS  Google Scholar 

  31. Kaupferman ME, Patterson DM, Mandel SJ, et al. (2004) Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope 114:403–406

    Article  Google Scholar 

  32. Ito Y, Tomoda C, Uruno T, et al. (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe City, 650-0011, Japan

    Yasuhiro Ito, Takuya Higashiyama, Yuuki Takamura, Akihiro Miya, Kaoru Kobayashi, Fumio Matsuzuka, Kanji Kuma & Akira Miyauchi

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  1. Yasuhiro Ito
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  2. Takuya Higashiyama
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  3. Yuuki Takamura
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  4. Akihiro Miya
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  5. Kaoru Kobayashi
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  7. Kanji Kuma
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  8. Akira Miyauchi
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Correspondence to Yasuhiro Ito.

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Ito, Y., Higashiyama, T., Takamura, Y. et al. Risk Factors for Recurrence to the Lymph Node in Papillary Thyroid Carcinoma Patients without Preoperatively Detectable Lateral Node Metastasis: Validity of Prophylactic Modified Radical Neck Dissection. World J Surg 31, 2085–2091 (2007). https://doi.org/10.1007/s00268-007-9224-y

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