Abstract
Although the roles of Delphian lymph node (DLN) metastasis in papillary thyroid cancer (PTC) have been previously reported, there are still limited data on correlations of clinicopathologic factors with DLN metastasis and unique patterns of cervical node subsite metastasis in PTC patients with DLN metastasis. We retrospectively reviewed medical records of 320 patients with a diagnosis of PTC who underwent primary surgery. Clinicopathologic features and DLN metastasis patterns were analyzed for predicting extensive cervical lymph node metastasis. Both univariate and multivariate Cox regression analyses were used to identify independent factors for cervical lymph node metastasis. DLN metastasis was significantly associated with multifocality, tumor size > 1 cm, extrathyroid extension, BRAFV600E mutation, central neck node metastasis (CNNM), and lateral neck nodes metastases. Patients with DLN metastasis had more lymph node metastases in the central compartment. CNNM number and tumor size > 1 cm were independent risk factors for DLN metastasis. DLN metastasis was highly predictive of lateral lymph node metastasis with moderate sensitivity and high specificity. DLN metastasis is associated with several poor prognostic factors, including extensive cervical lymph node metastasis, and can serve as a predictor of advanced PTC. The presence of DLN metastasis should prompt surgeons to perform an aggressive surgery approach.
Highlights
Central neck nodes (CNNs; known as level VI nodes), which comprise the Delphian, pretreacheal, and paratracheal node groups, are the most common harbors of nodal metastasis in patients with papillary thyroid cancer (PTC)
Of the 320 patients included in the study, 157 (49.1%) had central neck node metastasis (CNNM), and 4 (1.3%) had Delphian lymph node (DLN) metastasis without metastasis to other central compartments
The univariate analysis revealed that, compared with patients without DLN metastasis, those with DLN metastasis had significantly higher rates of multifocality (47.6% vs. 28.0%, P = 0.015), tumor size > 1 cm (71.4% vs. 31.1%, P < 0.001), ETE (59.5% vs. 37.2%, P = 0.009), BRAFV600E mutation (64.3% vs. 47.6%, P = 0.026), paratracheal LNM (81.0% vs. 31.3%, P < 0.001), pretracheal LNM (64.3% vs. 23.2%, P < 0.001), and CNNM (90.5% vs. 41.5%, P < 0.001) and significantly more CNNMs (4.3 ± 3.0 vs. 2.3 ± 1.5, P < 0.001). (Table 2)
Summary
Central neck nodes (CNNs; known as level VI nodes), which comprise the Delphian (prelaryngeal), pretreacheal, and paratracheal node groups, are the most common harbors of nodal metastasis in patients with papillary thyroid cancer (PTC). The percentage of PTC patients with central neck node metastasis (CNNM) at primary diagnosis ranges from 20% to 53.7% [1,2,3,4,5,6]. Prophylactic central neck dissection (CND) of the affected side should be performed following thyroidectomy in intermediate- and high-risk PTC patients, as it may improve survival by reducing www.impactjournals.com/oncotarget locoregional recurrence and facilitating accurate disease staging [9,10,11]. PTC patients have been reported to have a high frequency of occult lateral node metastasis [12, 13]. The indications for prophylactic LND in PTC patients are controversial and remain unclear, as data for finding an optimal balance between its complications and benefits are limited
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