Risk factors of central lymph node metastasis of papillary thyroid carcinoma

Abstract

Due to the lack of an accurate preoperative diagnostic method of central lymph node metastasis (CLNM) of papillary thyroid cancer (PTC), the prophylaxis of central lymph node dissection remains controversial. The present study investigated the clinicopathological features of PTC patients and the risk factors of CLNM. The clinicopathological features of PTC patients with respect to sex, age, initial symptoms, observation, tumor diameter, multifocality, extrathyroidal invasion, and pathological data combined with other thyroid diseases, were analyzed retrospectively. The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model. The CLNM rate of PTC was 40.6% (1331/3273). On average, 7.0 (4.0, 12.0) central lymph nodes were dissected, and 3.70 (±3.8) lymph nodes were proved to be metastatic. Univariate analysis showed that sex (P < .001), age (P < .001), tumor diameter (P < .001), extrathyroid invasion (P < .001), multifocality (P = .001), concurrent nodular goiter (P < .001), initial symptoms (P < .001), and observation or not (P < .001) were related to CLNM. The observation time was neither related to CLNM (P = .469) nor extrathyroidal invasion (P = .137). Tumors localized in the lower part of the thyroid were the risk factors for CLNM (P < .001) while multifocality was unrelated (P = .68). The metastasis rate of bilateral multiple regions > unilateral multiple regions > single region (P = .003). Multivariate logistic regression analysis showed that sex, age, tumor diameter, extrathyroidal invasion, and observation were independent risk factors of CLNM. Male, younger age, large tumor size, and extrathyroidal invasion were independent risk factors for CLNM. CLNM was related to multiple regions occupied by tumors in the thyroid but unrelated to multifocality. The tumor occupying a single region and localized in the lower part of thyroid could be used as a predictive factor for CLNM. For tumors that could not be diagnosed as benign or malignant, observation may be an option, since no evidence of disease progression was presented during observation.

Analysis of patterns and risk factors regarding the onset of nodules in the contralateral thyroid lobe during follow‐up ultrasonography among patients after unilateral lobectomy for the treatment of papillary thyroid carcinoma

“…By comparing the baseline clinical characteristics between patients in the primary tumor size ≤1 cm group and primary tumor size 1 to 4 cm group (Table ), our study found that the primary tumor size 1 to 4 cm group tended to show higher incidence of ETE and LNM. This is partly in accordance with the result from a recent study indicating that tumor diameter is an independent risk factor of central lymph node metastasis (CLNM) . Thus, larger tumor diameter in size 1 to 4 cm group could contribute to the possibility of CLNM.…”

Clinicopathological Significance of Overall Frequency of Allelic Loss (OFAL) in Lesions Derived from Thyroid Follicular Cell

“…The frequency and the range of LOH/MSI, presented in our study as OFAL, significantly increases with tumor progression (clinical stages T2–T3), which is in concordance with the multistage model of carcinogenesis. The size of the tumor at the time of diagnosis is another important prognostic factor in the course of thyroid cancer [ 50 , 51 ]. Our study revealed that the highest percentage of allele loss was correlated with the diameter of the primary tumor being ≥ 3 cm, with a significant difference in the OFAL frequency compared with tumors < 1 cm.…”

Select Group of Patients Might Benefit From Prophylactic Central Lymph Node Dissection in Clinically Node Negative Papillary Thyroid Microcarcinoma

“…However, many studies had limitations such as postoperatively assessable factor analysis (e.g., pathologic tumor size or lymphovascular invasion), enrolled patients with a high risk of CLNM (e.g., patients with a primary tumor size of > 10 mm), or heterogeneous enrolled patients, including both clinically CLNM positive and negative. [20][21][22] According to these limitations, in this study, we enrolled PTMC patients with negative CLNM on preoperative physical examination, US, and PET/CT and analyzed only preoperatively assessable factors. We found that a SUVmax of the primary tumor of > 3 was an independent preoperatively assessable factor predictive of pathologic CLNM.…”

“…Patients with a larger tumor size have a higher risk of CLNM in PTC. 20 Furthermore, several studies have reported that tumor size is associated with CLNM even in cN0 PTMC. 22 Park et al and Wang et al exhibited that the tumor sizes > 7 mm and > 5 mm are significant predictive factors for CLNM in patients with cN0 PTMC.…”