Risk Factors for Central Compartment Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Meta‐Analysis

Qu, Ning; Zhang, Ling; Ji, Qing; Chen, Jia Ying; Zhu, Yong; Cao, Yi; Shen, Qiang

doi:10.1007/s00268-015-3108-3

Cited by 86 publications

(72 citation statements)

References 46 publications

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“…Male sex was a risk factor for LNM, which suggests that males require specialized neck checkups of the thyroid to enable the early detection of thyroid tumors 15. Patient age is known to be an important risk factor for patients with PTC >1 cm;31,32 our results indicated that younger age (<45 years) was associated with an increased risk of LNM in PTMC patients.…”

Section: Discussionmentioning

confidence: 59%

“…On the other hand, given the potentially high prevalence of LNM in PTMC, some authors agree that prophylactic lymph node dissection (LND) permits an improved staging of the disease that may guide subsequent treatment;14 however, few studies have demonstrated a meaningful role of prophylactic LND in relation to locoregional control or survival in PTMC. A systematic review that included 8,345 PTMC patients explored the risk factors associated with central lymph node metastasis (CLNM) and proposed that prophylactic central lymph node dissection (CLND) should be considered in PTMC patients with risk factors 15. However, the deficiency of long-term follow-up data for the analysis was a limitation in that study.…”

Section: Introductionmentioning

confidence: 99%

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Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Lin¹,

Qu²,

Shi³

et al. 2016

OTT

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“…To date, five meta‐analyses have been performed to identify the clinical risk factors for central neck lymph node metastases (CLNM) in PTC and papillary thyroid microcarcinoma (PTMC). These meta‐analyses found association between CLNM and several clinicopathological factors, including age, sex, tumor size, multifocality, tumor location, lymphovascular invasion, extrathyroidal extension (ETE), and lymphocytic thyroiditis . Two meta‐analysis also found that CLNM is associated with lateral neck lymph node metastasis (LLNM) .…”

Section: Introductionmentioning

confidence: 93%

Clinicopathological predictors of occult lateral neck lymph node metastasis in papillary thyroid cancer: A meta‐analysis

Zhan

Luo

et al. 2019

Head & Neck

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Background: This meta-analysis aimed to identify the clinicopathological factors that could predict the risk of occult lateral neck lymph node metastasis (OLLNM) in N0/N1a papillary thyroid cancer (PTC). Methods: A literature search of PubMed, Web of Science, OvidSP, and Chinese National Knowledge Infrastructure databases was performed using relevant keywords. Specific odds ratios and confidence intervals were calculated. Results: The final analysis included 15 studies with a total of 5342 patients. OLLNM was found to be significantly associated with some clinicopathological features, including age <45 years, male sex, extrathyroidal extension, tumor location in the upper pole, tumor size >10 mm, positive central lymph node metastasis, number of central lymph node metastasis ≥3, and vascular invasion. Conclusions: Fine-needle aspiration (FNA) cytology or FNA-Tg test might be an appropriate and reasonable intervention in the patients with N0/N1a PTC with an increased risk of OLLNM. K E Y W O R D S fine-needle aspiration, meta-analysis, occult lateral neck lymph node metastasis, papillary thyroid cancer, pathological features

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“…[3] Tumor location has been shown to be associated with neck metastasis. [4] There has been some interest in specific cases with rare locations and high biological activity, such as PTCs located in the isthmus, those with multiple foci and those with local invasion to adjacent tissues. [5] The thyroid isthmus lies directly anterior to the trachea, overlying the second to fourth tracheal rings and covered by the strap muscles, fascia and skin in the middle of the neck.…”

Section: Introductionmentioning

confidence: 99%

Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus

Lei²,

Qian³

et al. 2017

Medicine

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The frequency and pattern of lymph node metastasis and the extent of dissection for isthmic papillary thyroid carcinoma (PTC) remain unclear, and the aim of this present study was to evaluate these characteristics and to attempt to detect the best surgical protocol for isthmic PTCs. A total of 3185 consecutive patients with PTCs were reviewed. Of these patients, 47 with a single isthmic PTC were enrolled in our study, and matched 47 patients with a single PTC located in the unilateral lobe were randomly selected and added for comparison of their baseline tumor characteristics and lymph node metastasis characteristics. Univariate and multivariate analyses were performed to determine the risk factors for central lymph node metastasis in PTCs. The isthmic PTCs showed a higher rate of capsule invasion (P = .013) and advanced pathological N stage (P = .038) compared to the PTCs located in the lobe; meanwhile, pathological evidence of central lymph node metastasis (P = .040) was more frequent in the isthmic PTC group than in the control group. The univariate and multivariate analyses indicated that the tumors located in the isthmus (hazard ratio [HR]: 2.769; 95% confidence interval [CI]: 1.124–6.826; P = .027) and those with advanced (T2–4) pathological classifications (HR: 4.282; 95% CI: 1.224–14.976; P = .023) were independent risk factors for central lymph node metastasis in PTC patients. Due to the higher rate of pathological central lymph node metastasis and independent risk factors for central lymph node metastasis, total thyroidectomy, and bilateral central lymph node dissection should be considered the standard surgical protocol for isthmic PTCs.

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Risk Factors for Central Compartment Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Meta‐Analysis

Abstract: Prophylactic CLND may be performed in PTMC patients with clinically uninvolved central lymph nodes but with high risk factors; multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for central nodes in PTMC.

Cited by 86 publications

References 46 publications

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Clinicopathological predictors of occult lateral neck lymph node metastasis in papillary thyroid cancer: A meta‐analysis

Lymph node metastasis characteristics of papillary thyroid carcinoma located in the isthmus

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