Abstract
BackgroundsThe aim of this study is to investigate the risk factors for the cervical lymph node metastasis in papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data from the 966 PTC patients who underwent thyroid operation between January 2013 and December 2015 in the general surgery department of Shengjing Hospital of China Medical University were collected. The risk factors of predicting cervical lymph node metastasis were analyzed.ResultsMale, age ≤ 45 years old, tumor size> 1.0 cm, extrathyroidal extension (ETE), US features as microcalcification, were independent risk factors for central lymph node metastasis (CLNM) (P < 0.05). Only CLNM was independent risk factors for lateral lymph node metastasis (LLNM) (P < 0.05). The ROC curve showed that the cutoff value of the number of CLNM for predicting lateral lymph node metastasis was defined as 2.5 (Sensitivity = 0.535, Specificity = 0.722, AUC = 0.669, P < 0.05). When the number of CLNM > 3, OR value was significantly higher, suggesting that the risk of LLNM increased significantly. The incidence of LLNM in level III (66.8%) and level IV (67.3%) were significantly higher than level II (42.2%) and level V (21.3%) (P < 0.05). The incidence of LLNM and skip metastasis in tumor located in the upper 1/3 of the lobe was the highest (P < 0.05).ConclusionsProphylactic central lymph node dissection should be performed in patients with risk factors as male, age ≤ 45 years old, tumor size> 1.0 cm, ETE and US features as microcalcification. Lateral lymph node dissection (LLND) should be more actively performed in patients with the number of CLNM> 3. Extent of LLND should include levels II, III, IV and V. Tumor located in the upper 1/3 of the lobe was vulnerable for LLNM and skip metastasis, so lymph node in lateral compartment should be noticed when lymph node status was preoperatively evaluated by imaging examination.
Highlights
Thyroid carcinoma is the most common kind of malignant endocrine tumor, accounts for 1% of all human malignant tumors and 33% of the head and neck malignant tumors
All patients underwent central lymph node dissection (CLND), central lymph node metastasis (CLNM) was found in 367(38.0%) cases. 420 patients underwent the functional Lateral lymph node dissection (LLND), 211 cases had lateral lymph node metastasis (LLNM), including 155 cases with LLNM and CLNM simultaneously and 56 cases with skip metastasis
The multivariate analysis showed age ≤ 45 years old, male, tumor size> 1.0 cm, ETE and US features as microcalcification were the independent risk factors for CLNM (P < 0.05) (Table 3)
Summary
Thyroid carcinoma is the most common kind of malignant endocrine tumor, accounts for 1% of all human malignant tumors and 33% of the head and neck malignant tumors. The incidence of cervical lymph node metastasis in PTC can reach to 40– 90% [1]. Cervical lymph node metastasis was the main risk factor for a higher recurrence in PTC patient [2, 3]. The lymph node metastasis of PTC occurs in central compartment first, expands to the lateral compartment [4, 5], but it has the properties of skip metastasis. A reasonable and comprehensive initial surgical treatment can decrease the recurrence rate and the reoperation complications. In this study we retrospectively analyzed the clinicopathological data of 966 PTC patients, summarized the features and the risk factors for cervical lymph node metastasis, to help making a reasonable surgical plan and achieve the best treatment effectiveness
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