DOI QR코드

DOI QR Code

Risk Factors for Nodal Metastasis in cN0 Papillary Thyroid Microcarcinoma

  • Zhang, Li-Yang (General Surgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science) ;
  • Liu, Zi-Wen (General Surgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science) ;
  • Liu, Yue-Wu (General Surgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science) ;
  • Gao, Wei-Sheng (General Surgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science) ;
  • Zheng, Chao-Ji (General Surgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science)
  • Published : 2015.04.29

Abstract

Background: Despite the majority of papillary thyroid microcarcinoma (PTMC) patients having an excellent prognosis, cervical lymph node metastases are common. The purpose of this study was to investigate the incidence and the predictive risk factors for occult central compartment lymph node metastasis (CLNM) in PTMC patients. Materials and Methods: 178 patients with clinically node-negative (cN0) PTMC undergoing prophylactic central compartment neck dissection in our hospital from January 2008 to Jun 2010 were enrolled. The relationship between CLNM and the clinical and pathological factors such as gender, age, tumor size, tumor number, tumor location, extracapsular spread (ECS), and coexistance of chronic lymphocytic thyroiditis was analyzed. Results: Occult CLNM was observed in 41% (73/178) of PTMC patients. Multivariate analysis showed that male gender, tumor size (${\geq}6mm$) and ECS were independent variables predictive of CLNM in PTMC patients. Conclusions: Male gender, tumor size (${\geq}6mm$) and ECS were risk factors of CLNM. We recommend a prophylactic central lymph node dissection (CLND) should be considered in PTMC patients with such risk factors.

Keywords

Papillary thyroid microcarcinoma;central lymph node dissection;central lymph node metastasis

References

  1. Adolfo Pisanu, Alessandra Saba, Mauro Podda, et al (2014). Nodal metastasis and recurrence in papillary thyroid microcarcinoma. Endocrine, [Epub ahead of print].
  2. Choi YJ, Yun JS, Kook SH, et al (2010). Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 34, 1494-9. https://doi.org/10.1007/s00268-010-0541-1
  3. Connor MP, Wells D, Schmalbach CE (2011). Variables predictive of bilateral occult papillary microcarcinoma following total thyroidectomy. Otolaryngol Head Neck Surg, 144, 210-5. https://doi.org/10.1177/0194599810391616
  4. DeLellis RA, Lloyd RV, Heitz PU, et al (2004). Pathology and genetics of tumors of endocrine organs, in World Health Organization classification of tumors. (IARC Press, Lyon):64-6.
  5. Dunki-Jacobs E, Grannan K, McDonough S, et al(2012). Clinically unsuspected papillary microcarcinomas of the thyroid: a common finding with favorable biology? Am J Surg, 203, 140-4. https://doi.org/10.1016/j.amjsurg.2010.12.008
  6. Hughes DT, White ML, Miller BS, et al (2010). Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery, 148, 1100-6. https://doi.org/10.1016/j.surg.2010.09.019
  7. Hay ID, Hutchinason M E, Gonzalez-Losada T, et al(2008). Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery, 144, 980-7. https://doi.org/10.1016/j.surg.2008.08.035
  8. He Q, Zhuang D, Zheng L, et al (2012). The surgical management of papillary thyroid microcarcinoma: a 162-month singlecenter experience of 273 cases. Am Surg, 78, 1215-8.
  9. Jovanovic L, Delahunt B, McIver B, et al (2010). Distinct genetic changes characterise multifocality and diverse histological subtypes in papillary thyroid carcinoma. Pathology.42:524-33. https://doi.org/10.3109/00313025.2010.508780
  10. Kim, K.-E., Kim, E.-K., Yoon, J.H. et al (2013). Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg, 37, 385-9. https://doi.org/10.1007/s00268-012-1826-3
  11. Lin KD, Lin JD, Huang MJ, et al (1997). Clinical presentations and predictive variables of thyroid microcarcinoma with distant metastasis. Int Surg, 82, 378-81.
  12. Lundgren CI, Hall P, Dickman PW, Zedenius J (2006). Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer, 106, 524-31. https://doi.org/10.1002/cncr.21653
  13. Mercante G, Frasoldati A, Pedroni C, et al (2009). Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid, 19, 707-16. https://doi.org/10.1089/thy.2008.0270
  14. Mazzaferri EL, Doherty GM, Steward DL (2009). The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid, 19, 683-9. https://doi.org/10.1089/thy.2009.1578
  15. Mazeh H, Samet Y, Hochstein D, et al (2011). Multifocality in well differentiated thyroid carcinomas calls for total thyroidectomy. Am J Surg, 201, 770-5. https://doi.org/10.1016/j.amjsurg.2010.03.004
  16. Palazzo FF, Gosnell J, Savio R, et al (2006). Lymphadenectomy for papillary thyroid cancer: changes in parctice over four decades[J]. European J Surg Oncol, 32, 340-4. https://doi.org/10.1016/j.ejso.2005.12.011
  17. Park JP, Roh JL, Lee JH, et al (2014). Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 208, 412-8. https://doi.org/10.1016/j.amjsurg.2013.10.032
  18. Roti E, Rossi R, Trasforini G, et al (2006). Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab, 91, 2171-8. https://doi.org/10.1210/jc.2005-2372
  19. Vergez S, Sarini J, Percodani J, et al (2010). Lymph node management in clinically node-negative patients with papillary thyroid carcinoma. Eur J SurgOncol, 36, 777-82.
  20. White ML, Gauger PG, Doherty GM (2007). Central lymph nodedissection in differentiated thyroid cancer. World J Surg, 31, 895-904. https://doi.org/10.1007/s00268-006-0907-6
  21. Yang Y, Chen C, Chen Z, et al (2014). Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol, 81, 282-8. https://doi.org/10.1111/cen.12417
  22. Zhao Q, Ming J, Liu C, et al (2013). Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol, 20, 746-52. https://doi.org/10.1245/s10434-012-2654-2

Cited by

  1. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence vol.69, pp.2, 2017, https://doi.org/10.1007/s13304-017-0438-8
  2. Risk factors of central lymph node metastasis of papillary thyroid carcinoma vol.96, pp.43, 2017, https://doi.org/10.1097/MD.0000000000008365
  3. Analysis of Malignant Thyroid Neoplasms with a Striking Rise of Papillary Microcarcinoma in an Endemic Goiter Region pp.0973-7707, 2017, https://doi.org/10.1007/s12070-017-1156-8
  4. Incidental and non-incidental thyroid microcarcinoma vol.12, pp.1, 2016, https://doi.org/10.3892/ol.2016.4640
  5. Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma vol.26, pp.6, 2016, https://doi.org/10.1089/thy.2015.0429
  6. The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma pp.1573-2606, 2018, https://doi.org/10.1007/s11154-018-9474-z
  7. V600E Confers Male Sex Disease-Specific Mortality Risk in Patients With Papillary Thyroid Cancer vol.36, pp.27, 2018, https://doi.org/10.1200/JCO.2018.78.5097
  8. Establishment and validation of the scoring system for preoperative prediction of central lymph node metastasis in papillary thyroid carcinoma vol.8, pp.1, 2018, https://doi.org/10.1038/s41598-018-24668-6