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Prognostic Significance of the Number of Metastatic Lymph Nodes to Stratify the Risk of Recurrence

World Journal of Surgery volume 38, pages 858–862 (2014)Cite this article

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.

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References

  1. 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

    Article  CAS  PubMed  Google Scholar 

  2. 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

    Article  CAS  PubMed  Google Scholar 

  3. Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin North Am 5:43–63

    CAS  Google Scholar 

  4. 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)

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  CAS  Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Article  CAS  PubMed  Google Scholar 

  15. Goretzki PE, Simon D, Frilling A et al (1993) Surgical reintervention for differentiated thyroid cancer. Br J Surg 80:1009–1012

    Article  CAS  PubMed  Google Scholar 

  16. 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

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Ajou University School of Medicine, Suwon, Korea

    Jeonghun Lee, Youngpeck Song & Euy Young Soh

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  1. Jeonghun Lee
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  2. Youngpeck Song
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  3. Euy Young Soh
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Correspondence to Euy Young Soh.

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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

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