Risk factors for high-volume lymph node metastases in cN0 papillary thyroid microcarcinoma

Abstract

Background: Lymph node metastasis (LNM) often occurs in clinical lymph node negative (cN0) papillary thyroid microcarcinoma (PTMC). The risk factors for LNM, especially for high-volume LNM, were investigated in this study. Methods:The medical records of 1,974 consecutive PTMC patients admitted to the Peking Union Medical College Hospital (PUMCH) from 2013 to 2015 were reviewed. Their clinicopathological features were collected. Univariate and multivariate analyses were performed to identify the risk factors for LNM/high-volume LNM.Results: Of all the patients, cervical lymph node metastases were detected in 690 patients (34.95%), and high-volume LNM was detected in 75 patients (3.80%). The results of univariate analysis revealed that sex, age, chronic thyroiditis, multifocality, and tumor diameter were significantly correlated with LNM (P<0.05) and that sex, age, multifocality, and tumor diameter were significantly correlated with high-volume LNM (P<0.05). Multivariate logistic regression analysis demonstrated that male sex [odds ratio (OR) =1.657, P<0.001], multifocality (OR =1.601, P<0.001), and tumor diameter >0.5 cm (OR =1.770, P<0.001) were independent risk factors for LNM; age of 40-59 years old (OR =0.427, P<0.001), age ≥60 years old (OR =0.291, P<0.001), and chronic thyroiditis (OR =0.562, P<0.001) were independent protective factors for LNM. For high-volume LNM, male sex (OR =2.250, P=0.002), tumor diameter >0.5 cm (OR =3.664, P=0.013) and multifocality (OR =2.034, P=0.004) were independent risk factors, whereas age ≥40 years old (OR =0.240, P<0.001) was an independent protective factor.Conclusions: Lymph node metastases are common in cN0 PTMC, whereas high-volume LNM is rare.Active surveillance may be reasonable for patients with tumor diameter ≤0.5 cm, age ≥40 years old, female sex and isolated lesions.

Predictive Factor of Large‐Volume Central Lymph Node Metastasis in Clinical N0 Papillary Thyroid Carcinoma Patients Underwent Total Thyroidectomy

“…Previous studies have demonstrated that male sex, age, multifocality, tumor diameter>0.5cm and ETE were independent risk factors for LNM in PTMC patients (8)(9)(10). In this study, univariate and multivariate analyses revealed that age <45 years and male gender are independent predictive factors for large-volume CLNM in cN0 PTC patients.…”

Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm

“…[ 18 ] Recently, some studies also showed multifocality as the risk factor of high-volume (i.e., >5 metastatic lymph nodes) CLNMs in PTC. [ 23 , 29 ] However, multifocal lesions according to ultrasonography showed no significant relation with the presence of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm in our study. The results of our study were in accordance with those reported by Huang et al, wherein the multifocal lesions determined by preoperative ultrasound were not considered as risk factor for high-volume CLNMs in cN0 PTMC.…”

Predicting non-small-volume central lymph node metastases (>5 or ≥2 mm) preoperatively in cN0 papillary thyroid microcarcinoma without extrathyroidal extension

“…Age is known to be an important prognostic factor for patients with PTMC. Previous studies have reported that younger age is an increased risk of CLNM [ 34 – 36 ] and high-volume (ie, >5 metastatic lymph nodes) CLNM [ 37 , 38 ] in cN0 PTMC patients. In addition, Miyauchi et al have reported that <40 years of age is the only significant risk factor for tumor size enlargement and novel appearance of lymph node metastasis of PTMC during active surveillance.…”

“…[ 41 ] However, men tend to more advanced disease diagnosed at an older age, lower disease-free survival, and higher mortality. [ 42 ] Previous studies have demonstrated that male sex is a significant risk factor for CLNM [ 34 – 36 ] and high-volume (ie, >5 metastatic lymph nodes) CLNM [ 37 , 38 ] in cN0 PTMC patients. Furthermore, Nixon et al have reported that male sex is the risk factor associated with central neck node recurrence in PTC patients without pCND.…”