The stratification of patient risk depending on the size and ratio of metastatic lymph nodes in papillary thyroid carcinoma

Abstract

BackgroundThe aims of this study were to identify the clinical significances of the size of metastatic lymph node (mLN) and LN ratio (LNR) and to attempt to create a risk stratification for papillary thyroid carcinoma (PTC) patients.MethodsWe investigated the 435 PTC patients who underwent radioactive iodine (RAI) ablation treatment following thyroid surgery. The patients were classified into two groups (micrometastasis (pN1mic) ≤ 0.2 cm and macrometastasis (pN1mac) > 0.2 cm) and were stratified into the following three risk groups: group I (pN1mic, LNR ≤ 0.5); group II (pN1mic, LNR > 0.5 or pN1mac, LNR ≤ 0.5); and group III (pN1mac with LNR > 0.5). And then we investigated the association of the classified groups and variable clinicopathologic factors.ResultsThe clinical characteristics such as large tumor size, extrathyroidal extension, higher T stage, and greater number of mLN or LNR were significantly associated with pN1mac. The mean stimulated thyroglobulin levels were increased with the patient risk groups (p = 0.02). The recurrence-free survivals were significantly different between the stratified groups (p = 0.001).ConclusionsThe patient groups I, II, and III may be referred to as low-, intermediate-, and high-risk groups. Clinicians should consider the possibility of recurrence, and the decisions about the application of RAI ablation based on the size of mLN and the patient’s risk groups.

WITHDRAWN: The Clinical and Prognosis Value of the Number of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma Patients

“…There were great differences in cervical LNM of PTC patients in our hospital and there was no uni ed standard for the number of LNs dissections per patient. A quite few [12][13][14] articles found that a greater NMLNs might be associated with lower survival. Similarly, patients with NMLNs ≥5 were divided into intermediate risk in the improved risk strati cation of recent ATA guideline [1].…”

“…On the one hand, many scholars have tried to establish a standard for recurrence risk strati cation of PTC patients according to the characteristics of metastasis LNs. They found that the risk of recurrence was higher among PTC patients with larger metastatic LNs or higher mLNR [11][12][13][14]. As declared in the most recent American Thyroid Association (ATA) risk strati cation system, the recurrence rate of pN1 PTC with ≤5 LNs involved or >5 LNs involved is 5% and 20%, respectively [1].…”

“…Nevertheless, in the AJCC TNM staging system [15], postoperative LN involvement was only divided into CLNM alone (pN1a) and LLNM (pN1b). Thus, many scholars suggested that adding the features of metastatic LNs into the current American Joint Committee on Cancer (AJCC) staging system [12,14]. On the other hand, some investigators tried to analyze the clinical response of PTC patients with different characteristics of metastatic LNs.…”

“…Because there is no requirement for a minimum number of lymph nodes to be sampled, the clinical management of cervical LNs for PTC patients is still controversial [14]. This retrospective study explored the relationship between the features of LNM and NMLNs and outcome in PTC patients, and aimed to provide substantial evidence in the medical practice of PTC.…”

Nodal characteristics associated with adverse prognosis in oral cavity cancer are linked to host immune status

“…In other words, an enlarged lymph node with only a small metastatic focus may represent an efficient local immune response compared to a smaller node that has been completely replaced by metastatic tumor. Additionally, none of our 245 pN+ patients had a metastatic lymph node or a metastatic focus that measured greater than 6 cm, meaning that no OSCC patient was eligible for the pN3a category based on maximal lymph node size as per AJCC8.Studies in thyroid cancer have analyzed the role of the size of the metastatic focus within the involved node instead of the overall size of the metastatic lymph node, showing that it has value in outcomes prediction [18][19][20][21][22]. But to the best of our knowledge, Deng et al20 are the only authors that have evaluated the actual relationship between the size of the largest metastatic lymph node and the size of the largest metastatic focus.…”