The Prevalence of Extranodal Extension in Papillary Thyroid Cancer Based on the Size of the Metastatic Node: Adverse Histologic Features Are Not Limited to Larger Lymph Nodes

Rowe, Meghan E.; Özbek, Umut; Machado, Rosalie; Yue, Lauren E.; Hernández-Prera, Juan C.; Valentino, Alessandro; Qazi, Muhammad; Brandwein‐Weber, Margaret; Liu, Xulei; Wenig, Bruce M.; Urken, Mark L.

doi:10.1007/s12022-018-9518-7

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…Macroscopic ENE was found in 10.4% of PTC patients, and lung metastasis was found in 2.3% of patients. Macroscopic ENE and lung metastasis rates were similar to the published literature [9][10][11]4]. After multivariate logistic regression analysis, macroscopic ENE, macroscopic ETE and number of positive nodes showed association with lung metastasis, which indicated the independent predictive value.…”

Section: Discussionsupporting

confidence: 85%

Extranodal Extension Is an Independent Predictor of Lung Metastasis in Papillary Thyroid Cancer

Hei

Gong

Zheng

et al. 2021

Preprint

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PurposeLymph node metastasis is common in patients with papillary thyroid cancer (PTC). Some metastatic lymph nodes may present extranodal extension (ENE). The clinical role of ENE in PTC has yet to be clearly identified. We evaluated macroscopic ENE as a potential prognostic indicator of lung metastasis in PTC.Patients and MethodsWe identified 1140 consecutive patients who had PTC initially resected at our cancer center. Clinical data and pathological results were reviewed. Univariate and multivariate logistic regression analyses were used to figure out the association between clinicopathological variables and lung metastasis.ResultsIn this cohort, 51.7% of PTC patients had lymph node metastasis; 10.4% had macroscopic ENE positive nodes; 2.3% had lung metastasis. In patients with lymph node metastasis, the average number of positive nodes was 5.10 ± 4.91. Multivariable analysis of clinicopathological factors revealed that extrathyroidal extension (odds ratio [OR], 3.57; 95% CI, 1.41–9.04), macroscopic ENE (OR, 7.08; 95% CI, 2.54–19.74), and number of positive nodes were significantly associated with lung metastasis. Compared with 0–3 positive nodes, 7–9 positive nodes denoted a moderate risk of lung metastasis (OR, 4.53; 95% CI, 1.03–19.85). And 10 positive nodes or more indicated a high risk of lung metastasis (OR, 9.63; 95% CI, 2.65–35.02).ConclusionMacroscopic ENE could serve as a strong independent prognostic factor of lung metastasis in PTC. More attention should be paid to patients with ENE positive nodes during follow-up.

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Section: Discussionsupporting

confidence: 85%

Extranodal Extension Is an Independent Predictor of Lung Metastasis in Papillary Thyroid Cancer

Hei

Gong

Zheng

et al. 2021

Preprint

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“…Roh et al [4] found that sex, ETE, N1 classi cation, and number of positive nodes were all signi cant factors associated with occurrence of ENE. Other studies have demonstrated that large tumor size [22] and lymph node size [23] increase the risk of ENE for metastatic PTC.…”

Section: Discussionmentioning

confidence: 96%

Male patients with papillary thyroid cancer have a higher risk of extranodal extension

et al. 2022

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Purpose: There is a sex disparity in papillary thyroid cancer (PTC). Male sex is associated with a higher likelihood of advanced stage disease. This study aimed to examine the signi cance of sex for extranodal extension (ENE) in PTC.Patients and Methods: We reviewed the data of PTC patients who had undergone initial surgical resection from July 2012 to December 2014 (N = 1531). The effects of sex and other clinicopathological factors on ENE were investigated.Results: Of 1531 patients identi ed, 377 (24.6%) were male, 816 (53.3%) had positive nodes, and 256 (16.7%) had ENE. Compared with female patients, male patients had a higher risk of ENE (P < 0.001).Multivariable analysis of clinicopathological factors revealed that male sex (odds ratio [OR], 1.98; 95% con dence interval [CI], 1.37 -2.87; P < 0.001), age older than 60 years (OR, 1.93; 95% CI, 1.08 -3.35; P = 0.023), extrathyroidal extension (OR, 3.52; 95% CI, 2.42 -5.14; P < 0.001), bilateral multifocality (OR, 2.18; 95% CI, 1.53 -3.13; P < 0.001), and more positive nodes were signi cantly associated with increased risk of ENE. Patients with 6-10 positive nodes were 16.45-fold higher to have ENE than patients with 5 positive nodes or less (95% CI, 11.07 -24.68; P < 0.001).Conclusion: Male PTC patients had a higher risk of ENE than female. Sex was an independent predictor of ENE. The underlying mechanism needs to be investigated further.

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“…Second, the average follow-up time was 7.4 years (89 months), which may be shorter than recurrence time for PTMC. Third, in addition to the number and diameter of metastatic lymph nodes, extranodal extension has been identified as prognostic factor for thyroid cancer (40). However, extranodal extension was not mandated in the pathologic report before 2013 in our hospital, which may generate some bias in our study.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Recurrence for Multifocal Papillary Thyroid Microcarcinoma With Brafv600e Mutation: A Single Center Study of 1,207 Chinese Patients

et al. 2019

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Background: The American Thyroid Association (ATA) guidelines risk stratify Braf v600e mutated multifocal papillary thyroid microcarcinoma (BMPTMC) into different recurrence risk groups by the extent of extrathyroidal extension (ETE). These findings and modifications for BMPTMC need to be verified in additional studies. Methods: A retrospective cohort study was conducted in BMPTMC patients who underwent total thyroidectomy (TT) and central lymph node dissection (CLND) from 2008 to 2013. Overall, 1,207 patients were included, and predictive factors were identified by univariate and multivariate analysis over a mean 7.5-year follow up. Results: BMPTMC with ETE to capsule shows the same recurrence rate (3.8%) with intrathyroidal BMPTMC. Moreover, BMPTMC with ETE only to strap muscle, which belongs to high-risk group according to ATA guideline, shows relatively lower recurrence rate (13.3%) compared with some intermediate risk categories such as cN1 and >5 pN1. Multivariate analysis using a Cox proportional hazards regression model shows that total tumor diameter (TTD) is associated with significantly higher recurrence for BMPTMC with or without other risk factors (Hazard Ratio (HRO) = 9.86 [95%CI 5.35–18.20], p = 0.00; HRO = 2.32 [95%CI 1.12–4.85], p = 0.02; respectively), while Hashimoto thyroiditis (HT) is found to be protective against the recurrence (HRO = 0.51 [95%CI 0.33–0.79], p = 0.00; HRO = 0.47 [95%CI 0.25–0.89], p = 0.02; respectively). Conclusions: Taken together, capsular ETE and gross ETE to the strap muscles did not have the expected significant influence on recurrence for Chinese BMPTMC patients who underwent TT and CLND. Rather than the extent of ETE, TTD and the lack of HT were identified as predictors for recurrence among BMPTMC with or without other risk factors (vascular invasion, cN1, pN1>5, pN1>3 cm).

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The Prevalence of Extranodal Extension in Papillary Thyroid Cancer Based on the Size of the Metastatic Node: Adverse Histologic Features Are Not Limited to Larger Lymph Nodes

Cited by 15 publications

References 13 publications

Extranodal Extension Is an Independent Predictor of Lung Metastasis in Papillary Thyroid Cancer

Extranodal Extension Is an Independent Predictor of Lung Metastasis in Papillary Thyroid Cancer

Male patients with papillary thyroid cancer have a higher risk of extranodal extension

Predictive Factors of Recurrence for Multifocal Papillary Thyroid Microcarcinoma With Brafv600e Mutation: A Single Center Study of 1,207 Chinese Patients

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