Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Sun, Wei; Lan, Xiabin; Zhang, Hao; Dong, Wenwu; Wang, Zhihong; He, Liang; Zhang, Ting; Liu, Siming

doi:10.1371/journal.pone.0139021

Cited by 119 publications

(122 citation statements)

References 67 publications

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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). In this study, the authors found that there was an increased risk of central lymph node metastases in clinical N0 patients with LVI (OR = 4.35, 95% CI: 2.24-8.46, P < 0.01).…”

Section: Discussionsupporting

confidence: 93%

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: 93%

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Pontius¹,

Youngwirth²,

Thomas³

et al. 2016

Endocrine-Related Cancer

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“…Previous studies have reported several risk factors for CLNM in PTC patients, such as age, size, multifocal, and genetic mutations . However, most of these risk factors are determined after surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and ultrasonographic features for predicting central lymph node metastasis in clinically node‐negative papillary thyroid carcinoma without capsule invasion

Yao

Zhou

et al. 2019

Head & Neck

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Background To evaluate the association of preoperative clinical and sonographic features with central lymph node metastasis (CLNM) in patients with clinically node‐negative (cN0) papillary thyroid carcinoma (PTC) without capsule invasion. Methods Clinical and sonographic features of 635 cN0 PTC nodules without capsule invasion were retrospectively reviewed. CLNM was confirmed by pathology. Univariate and multivariate analyses were performed to analyze the predicting factors associated with CLNM in cN0 PTC without capsule invasion. Results In the 635 cN0 PTC nodules without capsule invasion, age ≤36 years, male, tumor size >8 mm, the distance between the tumor and the capsule ≤1.1 mm and calcification were independently associated with CLNM (P < .05). Conclusions CLNM was associated with age, sex, tumor size, the distance between the tumor and the capsule, and calcification in cN0 PTC without capsule invasion. Preoperative assessment of risk factors could help to select PTC patients who benefit from surgery.

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“…PTMC with these pathological characters exhibit more aggressive biological behavior (42). Multifocality was considered the intraglandular spread of the primary tumor, which indicated the tumor cells were apt to shed off from primary lesion and distribute in thyroid (46,47). When the primary lesion penetrated the fibrous capsule of thyroid, the tumor cells metastasized easier without the restrain of the capsule (29).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

Tao

Wang

et al. 2016

Molecular and Clinical Oncology

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Currently the surgical approach for papillary thyroid microcarcinoma (PTMC), particularly the range of lymph node dissection, remains controversial. The present study aims to evaluate the risk factors for central and lateral lymph node metastasis (CLNM and LLNM) for appropriate clinical decision of neck lymph node dissection in PTMC. A total of 66 cases of PTMC that underwent unilateral or bilateral lobectomy plus prophylactic cervical lymph node dissection were collected for clinicopathological evaluation, including age, gender, tumor size, subtypes, extrathyroidal invasion, multifocality, calcifications, loss of cellular polarity/cohesiveness (LOP/C) in the invasive front, CLNM and LLNM, and retrospectively analysis. Univariate analysis revealed that LOP/C was significantly associated with CLNM (P=0.001) and LLNM (P<0.0001). The male gender was a risk factor of CLNM (P=0.04), while the age <45 years, tumor size >0.5 cm and multifocality were high-risk factors of LLNM (P=0.022, 0.044 and 0.005, respectively). Multivariable analysis revealed that LOP/C was significantly associated with CLNM [P=0.007, odds ratio (OR)=7.765, 95% confidence interval (CI)=1.773–33.996] and LLNM [P=0.029, OR=5.717, 95% CI=1.190–27.470]. Both multivariable analysis and χ2 test revealed that CLNM was another important high-risk factor of LLNM (P=0.021, OR=5.444, 95% CI=1.290–22.969, χ2=17.867, P<0.001). The present study revealed that prophylactic central lymph node dissection is essential for PTMC surgery and that prophylactic lateral lymph node dissection is recommend for patients with LOP/C and CLNM, which can be performed by intraoperative frozen section pathological examination. This must be considered discreetly in the case of patients with age <45 years, tumor size >0.5 cm and multifocal lesions.

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Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Cited by 119 publications

References 67 publications

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Lymphovascular invasion is associated with survival for papillary thyroid cancer

Clinical characteristics and ultrasonographic features for predicting central lymph node metastasis in clinically node‐negative papillary thyroid carcinoma without capsule invasion

Clinicopathological features for predicting central and lateral lymph node metastasis in papillary thyroid microcarcinoma: Analysis of 66 cases that underwent central and lateral lymph node dissection

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