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Prognostic Value of Lymph Node Yield and Metastatic Lymph Node Ratio in Medullary Thyroid Carcinoma

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Lymphadenectomy and thyroidectomy is standard treatment for medullary thyroid carcinoma (MTC), but the prognostic importance of the number of lymph nodes removed (lymph node yield, LNY) and the proportion of metastatic lymph nodes resected (metastatic lymph node ratio, MLNR) is unknown. We hypothesized that MTC survival is influenced by LNY and MLNR.

Methods

Patients (N = 534) who underwent thyroidectomy with lymphadenectomy for MTC between 1988 and 2004 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan–Meier method was used for univariate comparisons of survival for LNY and MLNR with a maximum follow-up of 12 years. Cox regression models adjusted for age, sex, extent of disease, tumor size, nodal status, LNY, and MLNR.

Results

By univariate analysis, increasing LNY was associated with improved survival in all patients (P < 0.002) and node-positive patients (P < 0.001). In a multivariate analysis using LNY and MLNR as categorical variables, significant factors influencing survival included: age (P < 0.001), tumor size (P < 0.001), LNY (P = 0.007), and MLNR (P < 0.02); in node-negative patients: age (P = 0.002); in node-positive patients: age (P < 0.001), tumor size (P < 0.001), and LNY (P = 0.001). Using LNY and MLNR as continuous variables, significant factors influencing survival included: age (P < 0.001), tumor size (P < 0.001), and MLNR (P = 0.01); in node-negative patients: age (P < 0.001); in node-positive patients: age (P < 0.001) and tumor size (P < 0.001).

Conclusion

In patients undergoing thyroidectomy and lymphadenectomy for MTC, LNY and MLNR predict poorer survival, but their impact on survival was limited to node-positive patients and was otherwise dominated by the effects of age and extent of disease.

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Acknowledgements

The authors wish to thank Dr. Scott A. Hundahl, VA Northern California Health Care System, Mather, California for his kind review of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, UC Davis Cancer Center, University of California at Davis, 4501 X Street, Suite 3010, Sacramento, CA, 95817, USA

    Maya D. Leggett MD, Steven L. Chen MD, MBA, Philip D. Schneider MD, PhD & Steve R. Martinez MD

Authors
  1. Maya D. Leggett MD
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  2. Steven L. Chen MD, MBA
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  3. Philip D. Schneider MD, PhD
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  4. Steve R. Martinez MD
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Corresponding author

Correspondence to Steve R. Martinez MD.

Additional information

Supported by Grant Number KL2RR024144 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

Presented in part at the 3rd Annual Academic Surgical Congress, February 12–15, 2008, Huntington Beach, California.

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Leggett, M.D., Chen, S.L., Schneider, P.D. et al. Prognostic Value of Lymph Node Yield and Metastatic Lymph Node Ratio in Medullary Thyroid Carcinoma. Ann Surg Oncol 15, 2493–2499 (2008). https://doi.org/10.1245/s10434-008-0022-z

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  • DOI: https://doi.org/10.1245/s10434-008-0022-z

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