Abstract
BackgroundWhether or not to perform prophylactic central lymph node dissection (CLND) in the case of clinically node-negative papillary thyroid cancer (PTC) is controversial. The purpose of this study was to investigate the risk factors for recurrence in clinically node-negative PTC patients who underwent total thyroidectomy plus bilateral central neck dissection and was verified pathologic N1a.MethodsWe retrospectively reviewed the medical records of 1082 PTC patients who underwent total thyroidectomy and prophylactic bilateral CLND between January 2004 and December 2012. We used Cox-proportional hazard regression analyses in order to explore potential predictive factors for recurrence.ResultsDuring a median follow-up (range) of 78 (12–158) months, recurrence occurred in 62 (5.7%) patients. Main tumor size more than 1 cm, gross extrathyroidal extension (ETE), positive lymph node (LN) more than 3, and LN ratio > 0.5 were all significantly associated with recurrence according to univariate analysis. In model I multivariate analysis (tumor size, gross ETE, LN ratio), LN ratio > 5 (hazards ratio [HR], 4.794; 95% confidence interval [CI], 2.674–8.595; p < 0.001) was found to be predictive of recurrence. Gross ETE (HR, 1.794; 95% CI, 1.024–3.143; p = 0.041) and positive LN more than 3 (HR, 2.505; 95% CI, 1.513–4.146; p < 0.001) were predictors for recurrence in model II multivariate analysis (tumor size, gross ETE, the number of positive LN).ConclusionsWe recommend that surgeons try to focus completely on performing prophylactic CLND for patients with suspicious gross ETE during preoperative evaluation. Close monitoring and thorough management are needed for clinically node-negative PTC patients with LN ratio of more than 0.5 and more than 3 positive LN in the central compartment.
Highlights
Whether or not to perform prophylactic central lymph node dissection (CLND) in the case of clinically node-negative papillary thyroid cancer (PTC) is controversial
According to recent guidelines from the American Thyroid Association (ATA), prophylactic CLND should be considered in patients with clinically central node-negative PTC who have advanced primary tumors (T3 or T4) or who are clinically node-positive in the lateral compartment, but it is not recommended for patients with small (T1 or T2), noninvasive, or clinically node-negative PTC [6]
Exclusion criteria were as followings: patients who were under 15 years old, who underwent completion thyroidectomy due to recurrence of any histologic type, who underwent thyroidectomy due to benign thyroid disease or other thyroid malignancy besides PTC, who underwent lateral neck dissection at first surgery, who were clinically node-positive in the central and lateral compartment, who did not undergo CLND, who were confirmed as having pathologic N0, who did not achieve R0 resection, who had distant metastasis upon first diagnosis, who had abnormal thyroid function test results prior to operation, who had less than a one year follow-up period, who experienced recurrence within one year after surgery, and who had other malignancies pre- or postoperatively
Summary
Whether or not to perform prophylactic central lymph node dissection (CLND) in the case of clinically node-negative papillary thyroid cancer (PTC) is controversial. The purpose of this study was to investigate the risk factors for recurrence in clinically node-negative PTC patients who underwent total thyroidectomy plus bilateral central neck dissection and was verified pathologic N1a. According to recent guidelines from the American Thyroid Association (ATA), prophylactic CLND should be considered in patients with clinically central node-negative PTC who have advanced primary tumors (T3 or T4) or who are clinically node-positive in the lateral compartment, but it is not recommended for patients with small (T1 or T2), noninvasive, or clinically node-negative PTC [6]. Even when LN metastases are revealed, clinicians can consider the omission of RAI therapy for patients with lower risk of recurrence in PTC
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