Abstract
The aim of this study was to evaluate the association between this characteristic and outcomes in patients with lymph node metastasis in a Brazilian cohort. This study examined a retrospective cohort of adult patients diagnosed with differentiated thyroid cancer and lymph node metastases from 1998 to 2015 in two referral centers. Number, location, size and extranodal extension (ENE) of metastatic lymph nodes were assessed and correlated with response to initial therapy. A greater number of metastatic nodes, larger size, presence of lateral neck disease and ENE were all associated with a lower probability of achieving an excellent response to initial therapy (p ≤ 0.05 for all these parameters). Local recurrent disease had a significant association with lymph node number (6 in the recurrence/persistence group versus 4 in the non-recurrent group; p = 0.02) and ENE (19.2 versus 75%, p = 0.03). Lateral neck disease was the only characteristic associated with distant metastasis and was present in 52.1% of the group without metastasis and 70.4% of the group with metastasis (p = 0.001). The lymph node characteristics were associated with response to initial therapy and neck recurrence/persistence, confirming the importance of the analysis of these factors in risk stratification in a Brazilian population and its possible use to tailor initial staging and long term follow-up.
Highlights
Differentiated thyroid cancer (DTC) is the cancer with the highest increase in the incidence in the United States [1]
In 2015, the American Thyroid Association (ATA) recognized the importance of these factors and recommended that patients be considered as low risk when there is no evidence of clinical nodal metastases or when micrometastases in five or fewer lymph nodes is present
The present study analyzed the characteristics of tumor and metastatic lymph nodes in patients with differentiated thyroid cancer (DTC), associating them with response to initial therapy, lymph node recurrence/ persistence and the presence of distant metastases
Summary
Differentiated thyroid cancer (DTC) is the cancer with the highest increase in the incidence in the United States [1]. Most studies show that the presence of lymph node metastases has little impact on overall survival, being more significant in older patients despite a great impact on recurrence/ persistence rates and impairment of quality of life in all age groups [4,5]. Lymph node characteristics such as number, size, location and extranodal extension (ENE) have been shown to have great impacts on the risk of nodal disease recurrence/ persistence [7]. In 2015, the American Thyroid Association (ATA) recognized the importance of these factors and recommended that patients be considered as low risk when there is no evidence of clinical nodal metastases (cN0) or when micrometastases (less than two millimeters) in five or fewer lymph nodes is present. From 2010 until the present, the functional sensitivity was reduced to 0.1 ng/mL
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