Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2015

01-01-2015 | Endocrine Tumors

Risk Factors for Recurrence of Papillary Thyroid Carcinoma with Clinically Node-Positive Lateral Neck

Authors: Chang Wook Lee, MD, Jong-Lyel Roh, MD, Gyungyup Gong, MD, Kyung-Ja Cho, MD, Seung-Ho Choi, MD, Soon Yuhl Nam, MD, Sang Yoon Kim, MD

Published in: Annals of Surgical Oncology | Issue 1/2015

Login to get access

Abstract

Background

Papillary thyroid carcinoma (PTC) with clinically node-positive lateral neck is more likely to recur after surgery than node-negative PTC. The present study investigated the risk factors for recurrence in PTC patients with clinically node-positive lateral neck.

Materials and Methods

This study involved 136 patients with pathologically confirmed PTC and a clinically lymph node (LN)-positive lateral neck but no initial distant metastasis who underwent total thyroidectomy with therapeutic central and lateral neck dissection. Clinicopathologic characteristics, intraoperative findings, postoperative thyroglobulin (Tg) levels, and post-treatment recurrences were examined. Univariate and multivariate analyses were performed to identify factors associated with recurrence-free survival (RFS).

Results

During a median follow-up of 62 months (range 33–90 months), 27 (19.9 %) patients had locoregional or distant recurrences. Univariate analyses showed that primary tumor size (p = 0.049), recurrent laryngeal nerve invasion (p = 0.035), the maximal size of metastatic LN foci (≥1.5 cm; p = 0.012), extranodal extension (p = 0.025), total LN ratio (≥0.26; p = 0.008), American Thyroid Association (ATA) risk categories (p < 0.001), and stimulated serum Tg level (≥4.4; p < 0.001) at the time of radioactive iodine ablation therapy just after thyroidectomy were significant predictors of RFS. Multivariate analyses showed that the maximal size of metastatic foci (p = 0.037), ATA risk categories (p < 0.001), and stimulated Tg level (p < 0.001) were independent predictors of RFS.

Conclusions

Maximal size of metastatic foci, ATA risk categories, and stimulated serum Tg levels are predictive of recurrence after surgery. Careful follow-up of patients with these risk factors is therefore recommended.
Literature
1.
Sivanandan R, Soo KC. Pattern of cervical lymph node metastases from papillary carcinoma of the thyroid. Br J Surg. 2001;88:1241–4.PubMedCrossRef
2.
Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in differentiated carcinoma of the thyroid. Am J Surg. 1996;172:692–4.PubMedCrossRef
3.
Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237:399–407.PubMedCentralPubMed
4.
Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg. 2007;245:604–10.PubMedCentralPubMedCrossRef
5.
Ito Y, Kudo T, Takamura Y, Kobayashi K, Miya A, Miyauchi A. Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection. World J Surg. 2012;36:593–7.PubMedCrossRef
6.
Edge SB, Byrd DR, Compton CC. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 87–96.
7.
Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106:524–31.PubMedCrossRef
8.
Baek SK, Jung KY, Kang SM, Kwon SY, Woo JS, Cho SH, et al. Clinical risk factors associated with cervical lymph node recurrence in papillary thyroid carcinoma. Thyroid. 2010;20:147–52.PubMedCrossRef
9.
Wada N, Masudo K, Nakayama H, Suganuma N, Matsuzu K, Hirakawa S, et al. Recommendation for subclass evaluation of TNM stage iva papillary thyroid carcinomas: T4aN1b patients are at risk for recurrence and survival. Ann Surg Oncol. 2008;15:1511–7.PubMedCrossRef
10.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.
11.
Porterfield JR, Factor DA, Grant CS. Operative technique for modified radical neck dissection in papillary thyroid carcinoma. Arch Surg. 2009;144:567–74.PubMedCrossRef
12.
Koo BS, Choi EC, Yoon YH, Kim DH, Kim EH, Lim YC. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg. 2009;249:840–4.PubMedCrossRef
13.
Kassouf W, Agarwal PK, Herr HW, Munsell MF, Spiess PE, Brown GA, et al. Lymph node density is superior to TNM nodal status in predicting disease-specific survival after radical cystectomy for bladder cancer: analysis of pooled data from MDACC and MSKCC. J Clin Oncol. 2008;26:121–6.PubMedCrossRef
14.
Ryu IS, Song CI, Choi SH, Roh JL, Nam SY, Kim SY. Lymph node ratio of the central compartment is a significant predictor for locoregional recurrence after prophylactic central neck dissection in patients with thyroid papillary carcinoma. Ann Surg Oncol. 2014;21:277–83.PubMedCrossRef
15.
16.
Vas Nunes JH, Clark JR, Gao K, Chua E, Campbell P, Niles N, et al. Prognostic implications of lymph node yield and lymph node ratio in papillary thyroid carcinoma. Thyroid. 2013;23:811–6.
17.
Kim TY, Kim WB, Kim ES, Ryu JS, Yeo JS, Kim SC, et al. Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2005;90:1440–5.PubMedCrossRef
18.
Kim SJ, Park SY, Lee YJ, Lee EK, Kim SK, Kim TH, et al. Risk factors for recurrence after therapeutic lateral neck dissection for primary papillary thyroid cancer. Ann Surg Oncol. 2014;21:1884–90.PubMedCrossRef
19.
Hughes DT, Miller BS, Cohen MS, Doherty GM, Gauger PG. Outcomes of total thyroidectomy with therapeutic central and lateral neck dissection with a single dose of radioiodine in the treatment of regionally advanced papillary thyroid cancer and effects on serum thyroglobulin. Ann Surg Oncol. 2014;21:1647–52.PubMedCrossRef
20.
Ito Y, Miyauchi A. Lateral and mediastinal lymph node dissection in differentiated thyroid carcinoma: indications, benefits, and risks. World J Surg. 2007;31:905–15.PubMedCrossRef
21.
Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery. 2004;135:139–48.PubMedCrossRef
22.
Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg. 2006;30:780–6.PubMedCrossRef
23.
Lipton RJ, McCaffrey TV, van Heerden JA. Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroidcarcinoma. Am J Surg. 1987;154:363–7.PubMedCrossRef
24.
Nishida T, Nakao K, Hamaji M, Kamiike W, Kurozumi K, Matsuda H. Preservation of recurrent laryngeal nerve invaded by differentiated thyroid cancer. Ann Surg.1997;226:85–91.PubMedCentralPubMedCrossRef
25.
Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery. 2006;139:357–62.PubMedCrossRef
26.
27.
Eustatia-Rutten CF, Smit JW, Romijn JA, van der Kleij-Corssmit EP, Pereira AM, Stokkel MP, et al. Diagnostic value of serum thyroglobulin measurements in the follow-up of differentiated thyroid carcinoma, a structured meta-analysis. Clin Endocrinol. 2004;61:61–74.CrossRef
Metadata
Title
Risk Factors for Recurrence of Papillary Thyroid Carcinoma with Clinically Node-Positive Lateral Neck
Authors
Chang Wook Lee, MD
Jong-Lyel Roh, MD
Gyungyup Gong, MD
Kyung-Ja Cho, MD
Seung-Ho Choi, MD
Soon Yuhl Nam, MD
Sang Yoon Kim, MD
Publication date
01-01-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 1/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3900-6

Other articles of this Issue 1/2015

Annals of Surgical Oncology 1/2015 Go to the issue

Endocrine Tumors

Chasing Calcitonin: Reoperations for Medullary Thyroid Carcinoma

Breast Oncology

Yes, Breast Surgeons May Provide Breast Cancer Genetic Assessment and Testing

Endocrine Tumors

Shear Wave Elastography in Evaluation of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma: Elasticity Index as a Prognostic Implication

Melanomas

Deep Lymph Node Metastases in the Groin Significantly Affects Prognosis, Particularly in Sentinel Node-Positive Melanoma Patients

Gastrointestinal Oncology

Sphincter Preservation Rates After Radical Resection for Rectal Cancer in the United States Veteran Population: Opportunity for Improvement in Early Disease

Breast Oncology

Race/Ethnicity and Disparities in Mastectomy Practice in the Breast Cancer Care in Chicago Study