Abstract
Background
Prophylactic dissection facilitates identification of central lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC). Because most staging systems do not stratify risks by the number of LN metastases, postoperative treatments vary among different institutions. Therefore we investigated the significance of number of LN metastases in risk stratification for recurrence in PTC.
Material and methods
A retrospective review was performed for 3,305 patients who had undergone thyroidectomy at Ajou University Hospital. A total of 2,462 patients (73.5 %) underwent total thyroidectomy, and another 3,152 (94.1 %) underwent central LN dissection. Lateral cervical LN dissection had been performed in 420 patients (12.5 %).
Results
There were 115 patients with recurrence (3.4 %). Recurrence-free rates were 94.6 % at 5 years and 89.4 % at 10 years. On univariate analysis, prognostic factors for recurrence were extent of thyroidectomy, tumor size, capsular invasion, T stage, N stage, number of LN metastasis, TNM stage, and radioactive iodine (RAI) therapy. On multivariate analysis, number of LN metastasis and N stage were significant prognostic factors for recurrence. Recurrence-free rate was significantly different between patients with 0–1 LN and those with 2 or more LN.
Conclusions
Number of metastatic LN was a significant prognostic factor, in addition to the N stage. Therefore, number of metastatic LN must be considered for postoperative staging system to tailor treatment and follow-up recommendations. In addition, patients with ≥2 metastatic LN may benefit from total thyroidectomy and RAI therapy with postoperative follow-up with serum thyroglobulin.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hundahl SA, Fleming ID, Fremgen AM et al (1998) A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995. Cancer 83:2638–2648
Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428
Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin North Am 5:43–63
Scheumann GF, Gimm O, Wegener G et al (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567. doi:10.4236/ss.2011.22012 (discussion 567–558)
Noguchi S, Noguchi A, Murakami N (1970) Papillary carcinoma of the thyroid. I. Developing pattern of metastasis. Cancer 26:1053–1060
Leboulleux S, Rubino C, Baudin E et al (2005) Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 90:5723–5729
Ito Y, Jikuzono T, Higashiyama T et al (2006) Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe. World J Surg 30:1821–1828. doi:10.1007/s00268-006-0211-5
Sugitani I, Kasai N, Fujimoto Y et al (2004) A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135:139–148
Shah PK, Shah KK, Karakousis GC et al (2012) Regional recurrence after lymphadenectomy for clinically evident lymph node metastases from papillary thyroid cancer: a cohort study. Ann Surg Oncol 19:1453–1459
White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904. doi:10.1186/1471-2482-13-S2-S3
Kim TY, Kim WB, Kim ES et al (2005) Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 90:1440–1445
Eustatia-Rutten CF, Smit JW, Romijn JA et al (2004) Diagnostic value of serum thyroglobulin measurements in the follow-up of differentiated thyroid carcinoma, a structured meta-analysis. Clin Endocrinol (Oxf) 61:61–74
Bonnet S, Hartl D, Leboulleux S et al (2009) Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab 94:1162–1167
Pattou F, Combemale F, Fabre S et al (1998) Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 22:718–724. doi:10.5812/ijem.3462
Goretzki PE, Simon D, Frilling A et al (1993) Surgical reintervention for differentiated thyroid cancer. Br J Surg 80:1009–1012
Chao TC, Jeng LB, Lin JD et al (1997) Reoperative thyroid surgery. World J Surg 21:644–647. doi:10.4174/jkss.2013.85.3.104
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, J., Song, Y. & Soh, E.Y. Prognostic Significance of the Number of Metastatic Lymph Nodes to Stratify the Risk of Recurrence. World J Surg 38, 858–862 (2014). https://doi.org/10.1007/s00268-013-2345-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2345-6