Abstract
To assess the prognostic value of lymph node ratio (LNR) in patients with stage IV thyroid cancer based on the Surveillance, Epidemiology, and End Results (SEER) database. A total of 4,940 eligible patients were included for the analysis. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to reveal the effect of LNR on overall survival (OS) and disease specific survival (DSS). The optimal cut-off value of LNR for predicting OS and DSS was determined by the time-dependent Receiver Operating Characteristic analysis. By the univariate Cox proportional hazard regression, LNR was significantly associated with OS and DSS in patients with medullary thyroid cancer (MTC), papillary thyroid cancer and anaplastic thyroid cancer (all P < 0.05). With the optimal cut-off value, Kaplan-Meier analysis showed that MTC patients with LNR≥76.5% were significantly associated with poorer OS (log-rank test: P < 0.0001), and LNR≥40.7% were significantly associated with poorer DSS (log-rank test: P < 0.0001). LNR was an independent prognostic factor of poorer survival in MTC patients after adjusting for other variables by multivariable Cox analysis (OS: hazard ratio [HR] = 2.560, 95% confidence interval [CI] 1.690–3.879, P < 0.0001; DSS: HR=2.781, 95% CI 1.582–4.888, P = 0.0004). Our results demonstrated that LNR could predict clinical outcomes in patients with stage IV MTC, and 76.5% was the optimal cut-off value of LNR to predict OS. LNR, as a function of the nodes positive and the nodes examined, could provide suggestions on the postoperative prognosis of patients with stage IV MTC.
Highlights
Thyroid cancer (TC) is the most common endocrine malignancy, and the incidence had been accelerating worldwide over the past few decades [1, 2]
Our results demonstrated that lymph node ratio (LNR) could predict clinical outcomes in patients with stage IV medullary thyroid cancer (MTC), and 76.5% was the optimal cut-off value of LNR to predict overall survival (OS)
A total of 4,940 eligible patients with Stage IV thyroid cancer were included in the present study (Table 1), containing four major histological types, papillary TC (PTC) (85.2%), follicular thyroid cancer (FTC) (1.1%), MTC (8.4%) and anaplastic TC (ATC, 5.6%)
Summary
Thyroid cancer (TC) is the most common endocrine malignancy, and the incidence had been accelerating worldwide over the past few decades [1, 2]. With the advances in treatment combined with early detection, 5-year survival of TC patients is excellent [5], especially for papillary TC (PTC). Nearly 30% to 80% patients of PTC have regional LN metastasis [6]. For follicular thyroid cancer (FTC) patients, the most common metastasized region is not LN but distant organs, such as lung and bone. The importance of LN dissection is not equivalent to all pathological types of TC patients. Therapeutic LN dissection for patients with clinically metastases is performed worldwide [7]
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