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The presence of cancerous nodules in lymph nodes is a novel indicator of distant metastasis and poor survival in patients with papillary thyroid carcinoma

  • Original Article – Clinical Oncology
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Abstract

Purpose

Several characteristics of lymph node metastasis (LNM) as predictors of the risk of recurrence or death were examined in patients with papillary thyroid carcinoma (PTC). The presence of cancerous nodules as a characteristic of LNMs in PTC has not yet been reported. The objective of this study was to evaluate the use of the cancerous nodules in the lymph node (CNLN) to determine the risk of distant metastasis and survival in patients with PTC.

Methods

This retrospective observational cohort study enrolled 1408 patients with pathologically confirmed PTC without initial distant metastasis who underwent thyroidectomy and neck dissection. All patients were divided into two groups (CNLN group and Non-CNLN group) according to the presence of CNLN.

Results

Multivariate analyses showed that the presence of a special histologic variant (OR 3.31), CNLN (OR 7.13), and lateral LNM (OR 4.02) was an independent factor predictive of distant metastasis. Distant metastasis was found in 23.1% and 2.3% of patients in the CNLN and Non-CNLN group, respectively (p < 0.001). Furthermore, tumor-specific death was found in 7.7% and 0.6% of patients in the CNLN and Non-CNLN group, respectively (p < 0.001). Patients in the CNLN group had a shorter distant metastasis-free survival and overall survival than patients in the Non-CNLN group (p < 0.001).

Conclusions

The presence of CNLN in patients with PTC is a novel indicator of distant metastasis and poor survival. PTC patients accompanied with CNLN should undergo more aggressive treatment and careful follow-up.

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    Authors and Affiliations

    1. Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China

      Ling Chen, Youzhi Zhu, Huihao Zhang, Hongkun Guo, Kunlin Wu, Lingjun Kong, Weihong Ruan, Jianying Hu, Xin Zhang & Xiangjin Chen

    2. Department of Pathology, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, Fujian Province, China

      Ke Zheng & Li Zhang

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    1. Ling Chen
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    2. Youzhi Zhu
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    3. Ke Zheng
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    4. Huihao Zhang
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    5. Hongkun Guo
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    11. Xin Zhang
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    12. Xiangjin Chen
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    Correspondence to Xiangjin Chen.

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    Funding

    This study was funded by the Key Clinical Specialty Discipline Construction Program of Fujian, P.R.C, Youth Research Project of Fujian Provincial Department of Health (2014-1-61) and Fujian Province Middle and Young Teacher Education Science and Technology Project Funding (JA14146).

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Ling Chen and Youzhi Zhu contributed equally to this paper.

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    Chen, L., Zhu, Y., Zheng, K. et al. The presence of cancerous nodules in lymph nodes is a novel indicator of distant metastasis and poor survival in patients with papillary thyroid carcinoma. J Cancer Res Clin Oncol 143, 1035–1042 (2017). https://doi.org/10.1007/s00432-017-2345-2

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    • DOI: https://doi.org/10.1007/s00432-017-2345-2

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