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Lateral lymph node metastasis in papillary thyroid microcarcinoma: a study of 5241 follow-up patients

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Abstract

Purpose

To investigate the impact of lateral lymph node metastasis in papillary thyroid microcarcinoma (PTMC).

Methods

5241 PTMC patients with follow-up information were enrolled in the current study. These patients underwent primary surgery in our situation from January 1997 to December 2016. Additionally, a validation cohort consisting of 274 PTMC patients who underwent primary surgery between January 2020 and December 2021 was also included. Univariable and multivariate logistic analyses were conducted to identify the association between clinicopathologic features and lateral lymph node metastasis (LLNM). Kaplan–Meier survival curve analysis was used to calculate the disease-free survival (DFS) rate. The fitting curve was generated to identify the quantitative relationship between central lymph node metastases (CLNM) and LLNM.

Results

Of 5241 PTMC patients, cervical lymph node metastasis was detected in 1494 (28.5%) cases, including 1364 (26.0%) with CLNM only and 130 (2.5%) with LLNM. With a median follow-up time of 60 months (interquartile range [IQR], 44–81), recurrence was detected in 114 patients (2.2%). Multivariate Cox regression analyses showed that LNM was the only independent risk factor for recurrence, with HR values of 3.03 in CLNM and 11.14 in LLNM, respectively. Tumor diameter >0.5 cm (hazard ratio [HR]:1.80), multifocality (HR:2.59), bilaterality (HR:2.13), extrathyroidal invasion (HR:2.13), and CLNM (HR:5.11) were independent risk factors for LLNM. The prevalence of LLNM escalated significantly with increasing number of lymph node involvement in CLNM when stratified by the number of metastatic lymph nodes and trend was observed similarly in the validation cohort. The fitting curve showed that the incidence of LLNM could be as high as 20.7% when the number of CLNM ≥ 5.

Conclusions

By analyzing a large database with follow-up information, our study provides evidence that LLNM is significantly correlated with tumor recurrence in patients with PTMC. Tumor size (>0.5 cm), multifocality, bilaterality, extrathyroidal extension (ETE) and CLNM are independent risk factors for LLNM.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81972495 to W.W. and No. 82102758 to S.C). We thank all participants for their contribution to the thyroid database.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81972495 to W.W. and No. 82102758 to S.C.).

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Author notes

  1. These authors contributed equally: Jiaying Ruan, Zhendong Chen

Authors and Affiliations

  1. Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Jiaying Ruan, Zhendong Chen, Shitu Chen, Zehang Xu, Liping Wen, Zhuochao Mao, Jian Liu & Weibin Wang

  2. Community Health Service Center, Jingjiang Street, Xiaoshan District, Hangzhou, China

    Jiejie Shen

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  1. Jiaying Ruan
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Correspondence to Jian Liu or Weibin Wang.

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This is an observational study. The study was approved by the Institutional Review Board of the First Affiliated Hospital, Zhejiang University School of Medicine.

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Ruan, J., Chen, Z., Chen, S. et al. Lateral lymph node metastasis in papillary thyroid microcarcinoma: a study of 5241 follow-up patients. Endocrine 83, 414–421 (2024). https://doi.org/10.1007/s12020-023-03486-5

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