Risk Factors for Central Lymph Node Metastases and Benefit of Prophylactic Central Lymph Node Dissection in Middle Eastern Patients With cN0 Papillary Thyroid Carcinoma.

Sandeep Kumar Parvathareddy,Khawla S Al-Kuraya,Fouad Al-Dayel,Saeeda O Ahmed,Felisa Devera,Saif S Al-Sobhi,Abdul K Siraj

doi:10.3389/fonc.2021.819824

Sandeep Kumar Parvathareddy, Khawla S Al-Kuraya + Show 5 more

Open Access

https://doi.org/10.3389/fonc.2021.819824

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Abstract

BackgroundProphylactic central lymph node dissection (PCLND) for adult patients with papillary thyroid carcinoma (PTC) is still a matter of debate. Data on incidence, risk and benefits of PCLND in Middle Eastern patients is lacking. Therefore, we aimed to identify the incidence and predictive clinico-pathological and molecular marker of PCLND in adult patients with clinically node negative (cN0) Middle Eastern PTC.MethodsThis retrospective study included 942 adult Middle Eastern patients with cN0 PTC who underwent total thyroidectomy (TT) or TT+PCLND. Clinico-pathological associations of central lymph node metastasis (CLNM) were assessed. Multivariate analysis was performed using logistic regression and Cox proportional hazards model.Results213 patients underwent PCLND and 38.0% (81/213) had positive CLNM. Multivariate analysis demonstrated age ≤55 years (Odds Ratio (OR) = 7.38; 95% Confidence Interval (CI) = 1.59 – 34.31; p = 0.0108), tumor bilaterality (OR = 3.01; 95% CI = 1.01 – 9.21; p = 0.0483), lymphovascular invasion (OR = 2.92; 95% CI = 1.18 – 7.23; p = 0.0206) and BRAF mutation (OR = 3.24; 95% CI = 1.41 – 7.49; p = 0.0058) were independent predictors of CLNM in adult PTC. Furthermore, patients who underwent PCLND showed significant association with improved recurrence-free survival (RFS; p = 0.0379). Multivariate analysis demonstrated that PCLND was an independent predictor of improved recurrence-free survival.ConclusionscN0 Middle Eastern PTC patients treated with PCLND showed a significantly better prognosis. PCLND was effective in improving RFS in Middle Eastern PTC patients and should be encouraged for patients with potential risk factors for CLNM.

Highlights

During the past two decades, the incidence of thyroid cancer has continually increased [1, 2]
Extrathyroidal extension was noted in 34.2% (322/942) of cases and lymphovascular invasion in 21.0% (198/942). 45.5% (429/ 942) of Papillary thyroid carcinoma (PTC) were multifocal and 27.2% (256/942) were bilateral. 80.0% (754/942) of PTC patients in our cohort received radioactive iodine (RAI) therapy
Among the 213 patients who underwent Prophylactic central lymph node dissection (PCLND), tumor recurrence was seen in only 8.5% (18/213) (Table 2)

Summary

Introduction

During the past two decades, the incidence of thyroid cancer has continually increased [1, 2]. Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers [3]. Most PTC patients have an excellent prognosis [5]. Despite this favorable outcome, PTC is prone to spread to the central lymph node (CLN). 20 – 40% of PTC patients have been reported to have CLN metastasis (CLNM) even in clinically node negative patients [6,7,8,9]. Prophylactic central lymph node dissection (PCLND) for adult patients with papillary thyroid carcinoma (PTC) is still a matter of debate. Risk and benefits of PCLND in Middle Eastern patients is lacking. We aimed to identify the incidence and predictive clinico-pathological and molecular marker of PCLND in adult patients with clinically node negative (cN0) Middle Eastern PTC

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