Relationship between subgroups of central lymph node metastasis and lateral lymph node metastasis in cN0 unilateral papillary thyroid carcinoma

Abstract

Objective To investigate the relationship between subgroups of central lymph node metastasis (sCLNM) and lateral lymph node metastasis (LNM) of unilatal papillary thyroid carcinoma (uPTC) with cervical lymph node negative (cN0). Methods The clinical and pathological data of 161 patients with cN0-uPTC who underwent total thyroidectomy+central lymph node dissection+lateral lymph node dissection from Jan. 2016 to Dec. 2016 were retrospectively analyzed. The relationship between the lymph node metastasis of each subarea in the central area of the affected side and the lymph node metastasis of the affected side was investigated. Results Binary logistic regression analysis of cN0-uPTC subregions in the affected central region showed: pre-laryngeal lymph node metastasis, pre-tracheal lymph node metastasis and paratracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected lateral region (P=0.008, 0.016, 0.035, respectively). Pre-laryngeal lymph node metastasis was an independent risk factor for lymph node metastasis in the affected area II (P=0.015). Pre-tracheal lymph node metastasis was an independent risk factor for lymph node metastasis in affected area III (P=0.004). Pre-tracheal and para-tracheal lymph node metastasis were independent risk factors for lymph node metastasis in the affected IV area (P=0.035, 0.011, respectively). Conclusions The lymph node metastasis pathway of thyroid cancer had certain regularity. The pre-laryngeal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area II. The pre-tracheal lymph node metastasis has the prediction value for the lymph node metastasis of the affected area III. The pre-tracheal and paratracheal lymph node metastasis have the prediction value for lymph node metastasis of the affected area IV. Lymph node dissection in affected areas III and IV needs to be considered in patients with pre-tracheal or paratracheal lymph node metastases. On this basis, lymph node dissection on the affected areas II, III, and IV might be considered if there is pre-laryngeal lymph node metastasis at the same time. Key words: Thyroid neoplasms; Papillary thyroid carcinoma; Lymphatic metastasis; Neck dissection