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Macroscopic extranodal extension is an independent predictor of lung metastasis in papillary thyroid cancer

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Abstract

Purpose

Lymph node metastasis is common in patients with papillary thyroid cancer (PTC). Some metastatic lymph nodes may present extranodal extension (ENE). The clinical role of ENE in PTC has yet to be clearly identified. We evaluated macroscopic ENE as a potential prognostic indicator of lung metastasis in PTC.

Patients and methods

We identified 1140 consecutive patients who had PTC initially resected at our cancer center. Clinical data and pathological results were reviewed. Univariate and multivariate logistic regression analyses were used to figure out the association between clinicopathological variables and lung metastasis.

Results

In this cohort, 51.7% of PTC patients had lymph node metastasis; 10.4% had macroscopic ENE positive nodes; 2.3% had lung metastasis. In patients with lymph node metastasis, the average number of positive nodes was 5.10 ± 4.91. Multivariable analysis of clinicopathological factors revealed that extrathyroidal extension (odds ratio [OR], 3.57; 95% CI, 1.41–9.04), macroscopic ENE (OR, 7.08; 95% CI, 2.54–19.74), and number of positive nodes were significantly associated with lung metastasis. Compared with 0–3 positive nodes, 7–9 positive nodes denoted a moderate risk of lung metastasis (OR, 4.53; 95% CI, 1.03–19.85). And 10 positive nodes or more indicated a high risk of lung metastasis (OR, 9.63; 95% CI, 2.65–35.02).

Conclusion

Macroscopic ENE could serve as a strong independent prognostic factor of lungmetastasis in PTC. More attention should be paid to patients with ENE positive nodes duringfollow-up.

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Data availability

The datasets generated analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This study was funded by Henan Health Commission (Grant No. 2018020490).

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Authors and Affiliations

  1. Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China

    Hu Hei, Wenbo Gong, Chen Zheng, Bin Zhou & Jianwu Qin

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  1. Hu Hei
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  2. Wenbo Gong
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  3. Chen Zheng
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  4. Bin Zhou
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Contributions

H.H. and J.W.Q. designed research; H.H., W.B.G., and C.Z. conducted research; H.H. and B.Z. analyzed data; H.H. wrote the paper; J.W.Q. had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Jianwu Qin.

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The authors declare no competing interests.

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The study was reviewed and approved by Institutional Review Board of the Affiliated Cancer Hospital of Zhengzhou University. This study was conducted in accordance with the Declaration of Helsinki.

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All authors have reviewed the final version of the manuscript and are in agreement its content and submission.

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Hei, H., Gong, W., Zheng, C. et al. Macroscopic extranodal extension is an independent predictor of lung metastasis in papillary thyroid cancer. Endocrine 77, 73–79 (2022). https://doi.org/10.1007/s12020-022-03045-4

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  • DOI: https://doi.org/10.1007/s12020-022-03045-4

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