Risk factors for recurrent disease in small papillary thyroid cancers – a Swedish register-based study

Abstract

Aims To study the correlation between clinicopathological risk factors and the risk for intervention-requiring cancer recurrence in patients with small papillary thyroid cancers (sPTCs). Materials and methods Records for 397 patients with sPTC (T1 ≤ 20mm) were obtained from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) between 2010 and 2016. Follow-up time was at least 5 years. Data regarding intervention-requiring cancer recurrence were obtained from patient medical records and analysed regarding lymph node (LN) status (N0, N1a and N1b) and recurrence. Results Age was significantly lower in the N1a and N1b groups compared to N0 (45 vs. 40.5 vs. 49 years, respectively; p = 0.002). Tumour size was smaller in the N1a group compared to N1b group (9 vs. 11.8 mm; p <0.01). The mean number of metastatic LNs at initial surgery was higher in the N1b compared to N1a group (6.6 vs. 3; p = 0.001), and in the recurrent compared to the non-recurrent group (7 versus 3.9; p <0.01). The recurrence rate was higher in the N1b group than the N1a and N0 groups (25% vs. 2.4% vs. 1.4%, respectively; p = 0.001). Conclusions Lymph node stage N1b at diagnosis, and having five or more metastatic nodes, are strong risk factors for cancer recurrence and decreased disease-free survival in sPTC. The management of patients with sPTC should include thorough lymph node mapping for optimal treatment and individual risk stratification.

Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study

“…LLNM is associated with a poor prognosis in patients ( 46 ). Nevertheless, the current indication for performing cervical lateral lymph node dissection in PTC cases remain subject to debate.…”

Preoperative risk stratification for patients with ≤ 1 cm papillary thyroid carcinomas based on preoperative blood inflammatory markers: construction of a dynamic predictive model

“…Previous studies have found associations among the number and maximum diameter of lymph node metastases and the malignancy of the primary tumor, as well as with postoperative local recurrence and survival prognosis for patients with PTC (10). Patients with small-volume or no lymph node metastasis demonstrate similar postoperative recurrence rates (11), which is significantly better than patients with meddle or large-volume lymph node metastasis (>5 lymph nodes and/or a metastatic focus diameter ≥ 0.2 cm) (12,13). Therefore, PTC patients with small-volume lymph node metastasis may be defined as low-risk preoperatively, allowing for the selection of more suitable treatment approaches.…”