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Effect of skip metastasis to lateral neck lymph nodes on outcome of patients with papillary thyroid carcinoma

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Abstract

Context

Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs).

Objective

The aim of this study was to explore the outcome of PTC patients with skip N1.

Patients and design

All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study.

Main outcome measure

Demographic and outcomes—recurrence and disease-specific survival (DSS)—were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement).

Results

During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8 years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74 months (range 12–216 months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10 years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group.

Conclusion

The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures.

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Authors and Affiliations

  1. Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Jean Baptiste Bertin, Fabrice Menegaux & Nathalie Chereau

  2. Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France

    Camille Buffet & Laurence Leenhardt

  3. Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France

    Camille Buffet, Laurence Leenhardt, Fabrice Menegaux & Nathalie Chereau

Authors
  1. Jean Baptiste Bertin
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  2. Camille Buffet
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  3. Laurence Leenhardt
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  4. Fabrice Menegaux
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  5. Nathalie Chereau
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Contributions

Jean Baptiste Bertin: study design—acquisition of data—analysis and interpretation of data—drafting of the manuscript. Camille Buffet: study design—critical revision of the manuscript. Laurence Leenhardt: study design—critical revision of the manuscript. Fabrice Menegaux: study design—analysis and interpretation of data—critical revision of the manuscript. Nathalie Chereau: study design—analysis and interpretation of data—critical revision of the manuscript.

Corresponding author

Correspondence to Nathalie Chereau.

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The authors declare no competing interests.

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Bertin, J.B., Buffet, C., Leenhardt, L. et al. Effect of skip metastasis to lateral neck lymph nodes on outcome of patients with papillary thyroid carcinoma. Langenbecks Arch Surg 407, 3025–3030 (2022). https://doi.org/10.1007/s00423-022-02604-7

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  • DOI: https://doi.org/10.1007/s00423-022-02604-7

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