Predictors of Level II and Vb Neck Disease in Metastatic Papillary Thyroid Cancer

Merdad, Mazin; Eskander, Antoine; Kroeker, Teresa R.; Freeman, Jeremy L.

doi:10.1001/2013.jamaoto.393

Cited by 25 publications

(17 citation statements)

References 23 publications

(30 reference statements)

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“…This is in agreement with several other studies that have established an association between LVI and cervical lymph node metastases (Merdad et al 2012, Sun et al 2015. In a systematic review, Sun and coworkers reviewed 20 studies and 9084 patients with PTC who underwent thyroidectomy with prophylactic lymph node dissection (Sun et al 2015).…”

Section: Discussionsupporting

confidence: 87%

“…LVI has also been shown to be associated with an increased risk of having lateral lymph node metastasis; Merdad et al presented a series of 185 patients with PTC who underwent selective neck dissection and showed that tumor LVI (OR = 5.52, s.e.m. = 0.03, P = 0.03) was an independent risk factor for having level Vb nodal involvement (Merdad et al 2012).…”

Section: Discussionmentioning

confidence: 89%

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Lymphovascular invasion is associated with survival for papillary thyroid cancer

Pontius¹,

Youngwirth²,

Thomas³

et al. 2016

Endocrine-Related Cancer

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Data are limited regarding the association between tumor lymphovascular invasion and survival for patients with papillary thyroid cancer (PTC). This study sought to examine lymphovascular invasion as an independent prognostic factor for patients with PTC undergoing thyroid resection. The National Cancer Data Base (2010-2011) was queried for patients with PTC who underwent total thyroidectomy or lobectomy. Patients were classified into two groups based on the presence/absence of lymphovascular invasion. Demographic, clinical and pathological features were evaluated for all patients. A Cox proportional hazards model was utilized to identify factors associated with survival. Results show that 45,415 patients met inclusion criteria; 11.6% had lymphovascular invasion. Patients with lymphovascular invasion were more likely to have larger tumors (2.8 cm vs 1.5 cm, P < 0.01), metastatic lymph nodes (74.1% vs 32.5%, P < 0.01), and distant metastases (3.0% vs 0.5%, P < 0.01). They were also more likely to receive radioactive iodine (69.3% vs 44.9%, P < 0.01). Unadjusted overall 5-year survival was lower for patients who had tumors with lymphovascular invasion (86.6% vs 94.5%) (log-rank P < 0.01). After adjustment, increasing patient age (HR = 1.06, P < 0.01), male gender (HR = 1.68, P < 0.01), presence of metastatic lymph nodes (HR = 1.77, P < 0.01), distant metastases (HR = 3.49, P < 0.01), and lymphovascular invasion (HR = 1.88, P < 0.01) were associated with compromised survival. For patients with lymphovascular invasion, treatment with RAI was associated with reduced mortality (HR = 0.43, P < 0.01). The presence of lymphovascular invasion among patients with PTC is independently associated with compromised survival. Patients who have PTC with lymphovascular invasion should be considered higher risk, and adjuvant RAI should be more strongly considered.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 89%

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Pontius¹,

Youngwirth²,

Thomas³

et al. 2016

Endocrine-Related Cancer

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“…Lymphovascular invasion was associated with lymph node metastases in a few studies. However, it did not prove to be a direct predictor of incomplete response to therapy [30,31].…”

Section: Discussionmentioning

confidence: 86%

Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital

Lopez

Valdez

et al. 2015

J Endocrinol Invest

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A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.

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“…Despite thyroid cancer being the most common head and neck cancer worldwide, the clinical significance of Delphian lymph node metastasis in thyroid cancer has not often been analysed. Several reports have shown a significant association between Delphian lymph node metastasis and LNM . When the Delphian lymph node is involved, the rate of LNM has been reported to range from 23.1% to 74% .…”

Section: Discussionmentioning

confidence: 99%

Lateral neck metastases in the ipsilateral and contralateral compartments of papillary thyroid carcinoma located in one lobe

Kim

Chang

et al. 2019

ANZ Journal of Surgery

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Background Papillary thyroid carcinoma (PTC) frequently involves lymph nodes in the lateral compartment, but PTC located in one lobe rarely metastasizes to bilateral lateral nodes. This study was designed to evaluate the clinicopathological features of patients with PTC limited to one lobe but with bilateral lateral neck metastasis (LNM). Methods Between January 2009 and December 2013, 698 patients with unilateral PTC with LNM were analysed. Of these patients, 651 had unilateral LNM (ULNM) and 47 had bilateral LNM (BLNM). The clinicopathological characteristics of the two groups were analysed. Results There were no significant between‐group differences in age, extrathyroidal extension, multifocality in one lobe, thyroiditis or psammomatous calcification. Male sex (51.1% versus 29.8%; P = 0.002), central compartment metastasis (91.5% versus 78.6%, P = 0.035), aggressive subtype of PTC (23.4% versus 8.8%; P = 0.001) and Delphian node metastasis (36.2% versus 18.1% versus 36.2%, P = 0.002) were significantly more frequent, and mean primary tumour size (1.79 ± 1.12 cm versus 1.34 ± 0.83 cm, P = 0.010) significantly larger in the BLNM than in the ULNM group. Conclusions Although few patients with PTC located in one lobe have BLNM, the contralateral lateral compartment should be carefully evaluated for BLNM in males and in patients with a primary tumour size >2 cm, aggressive subtype of PTC, central node metastasis and Delphian node metastasis.

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Predictors of Level II and Vb Neck Disease in Metastatic Papillary Thyroid Cancer

Cited by 25 publications

References 23 publications

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital

Lateral neck metastases in the ipsilateral and contralateral compartments of papillary thyroid carcinoma located in one lobe

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