Can Cervical Lymph Node Metastasis Increase the Risk of Distant Metastasis in Papillary Thyroid Carcinoma?

Abstract

BackgroundDistant metastasis (DM) is a rare event and has a negative effect on the prognosis for papillary thyroid carcinoma (PTC). The relationship between cervical lymph node metastasis and DM is complicated and unclear. This study aimed to evaluate the impact of N stage subclassification on different distant metastasis sites based on age stratification, especially for patients with papillary thyroid microcarcinoma.MethodsA total of 28,712 patient with PTC cases between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression analysis was utilized to adjust for confounding variables. Risk stratification, including positive lymph node number and lymph node ratio, was established by receiver operating characteristic curves to help predict DM.ResultsLung was the most common metastatic site regardless of N0, N1a disease, or N1b disease. As the N stage increased, the higher the rate of DM identified. After age stratification, only N1b disease significantly increased the risk of lung metastasis (LM; odds ratio, OR = 20.45, P < 0.001) rather than bone metastasis (BM; OR = 3.46, P > 0.05) in younger patients. However, in older patients, N1b disease significantly increased the risk of both LM (OR = 4.10, P < 0.001) and BM (OR = 2.65, P = 0.007). In patients with papillary thyroid microcarcinoma (PTMC), N1a disease did not increase the risk of DM, LM, and BM compared with N0 disease (P > 0.05). Furthermore, combined N stage with risk stratification has well performance in predicting DM (area under the curve, AUC = 0.761). Similar results were shown in PTC patients with LM (AUC = 0.770) and BM (AUC = 0.729).ConclusionOverall, the incidence of DM significantly increased with the progress of N disease after age stratification. N1a disease did not increase the risk of DM in PTMC patients, regardless of LM or BM. Combined N stage with risk stratification may be beneficial for DM prediction.

Clinical value of ultrasound parameters PI, TTP, and MTT in assessing cervical lymph node metastasis of papillary thyroid carcinoma

“…Papillary thyroid carcinoma (PTC) develops slowly, without causing obvious pain during the course of development, and it has a low rate of distant metastasis and death, so many potential patients are only identified postmortem [14,15].…”

Nomogram individually predicts the risk for distant metastasis and prognosis value in female differentiated thyroid cancer patients: A SEER-based study

“…Of these, T1 stage (17,175,63.6%), N0 stage (20,567, 76.2%), M0 stage (26,735, 99.0%), TNM I stage (21,072, 78.1%), and localized (19,039, 70.5%) were more common. Papillary (18,400 , 68 .2%) was the most common pathological subtype, followed by papillary with follicular variant (7,405,27.4%) and FTC (1,193, 4.4%). A percentage of 98.4% patients had undergone thyroidectomy.…”

“…DTC has a favorable prognosis, with a 10-year overall survival rate exceeding 90% ( 5 ). Nevertheless, a small number of DTC patients present with distant metastasis (DM) at initial diagnosis, which is the leading cause of thyroid cancer-related mortality ( 6 , 7 ). The risk factors for DM have been widely discussed in previous studies, but the results were inconsistent in patients with DTC.…”

Lateral lymph node metastasis in papillary thyroid cancer: Is there a difference between PTC and PTMC?

“…[1,2] Researchers like Feng et al [8] have posited that distinctions may exist between PTC and PTMC, which is supported by studies demonstrating differences between PTC and PTMC concerning lymph node metastasis in the central area. [9] Given that preoperative evaluation are commonly done with noninvasive ultrasound, the presence of cervical lymph node metastasis (CLNM) is harder to determine due to being more concealed anatomically. This brings significance to findings by Feng et al [10] that suggested PTC has a stronger tendency of lymph node metastasis (CLNM) in the central region.…”