Prognostic value of lymph node ratio in children and adolescents with papillary thyroid cancer

Abstract

Objective Neck lymph node (LN) metastasis is a common feature of paediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the paediatric population. Our purpose was to investigate the association of LNR with clinical outcomes in paediatric papillary thyroid cancer. Design & Methods The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analysed by univariate and multivariate analyses. Results Median number of positive LNs was 9, and median LNR was 0.4. During a median follow‐up of 49 months (range, 12.0‐139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR >0.34 exhibited a threefold higher risk of persistent disease after initial therapy than the counterparts (P = .02). Conclusion Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.

Predictive Factors for Recurrence of Papillary Thyroid Carcinoma in Children and Adolescents

“…Because of an increasing incidence of PTC in this age group, documentation of the prognosis and identification of predictors of DFS are of great clinical value. Our results showed that age at diagnosis, positive preoperative TSH level, maximal tumor size >2 cm, number of central and lateral LNM, lateral LNM, and N staging were risk factors for recurrence, similar to other research findings ( 20 – 22 ). In addition, we also found that the ATA pediatric risk stratification had predictive value for recurrent PTC patients in children and adolescents, the same results as other scholars’ research ( 22 , 23 ).…”

“…In addition, we also found that the ATA pediatric risk stratification had predictive value for recurrent PTC patients in children and adolescents, the same results as other scholars’ research ( 22 , 23 ). Multivariate analysis demonstrated that younger age (<14 years) at diagnosis and positive preoperative TSH were independent risk factors for recurrence, which were consistent with the results of other studies ( 20 – 25 ). The prognosis of pediatric PTC is generally excellent.…”

An individualized protein-based prognostic model to stratify pediatric patients with papillary thyroid carcinoma

“…However, unlike previous studies 25 , the lymph node metastasis rate of our study cohort did not suggest recurrence, which may be due to the different number of lymph node dissections.…”

Fourteen years old as the best age cutoff to differentiate prepubertal from pubertal papillary thyroid carcinoma

“…Prognostic factors, including RMLN, tumor extent, lateral lymph node involvement, and multifocal disease, have been reported to be associated with outcomes in the literature. 12,16,17 Shukla et al reported that decreasing age was related to the burden of nodal disease and the risk of extensive neck metastasis. 18 Redlich et al showed that younger age had an independent association with greater risk of recurrence and progression.…”