Abstract
BackgroundCervical lymph node metastasis of papillary thyroid carcinoma (PTC) is common. However, whether undergoing prophylactic central lymph node (CLN) dissection or lateral lymph node (LLN) dissections to prevent metastasis is still controversial. This study aimed to retrospectively investigate the risk factors of LLN metastasis in clinical lymph node-negative (cN0) PTC patients.MethodsWe retrospectively studied 783 lymph node-negative (cN0) PTC patients who underwent total thyroidectomy plus CLN dissection and LLN dissection.ResultsThe rates of CLN and LLN metastases were 68.2 and 47.4%, respectively. Large tumor size (> 20 mm) had a fourfold higher risk of LLN metastasis compared with small tumor size (≤ 20 mm; OR = 4.082, 95% CI 2.646–6.289; P = 0.001). Patients with tumor in the upper lobe had ~ 3-fold higher risk of LLN metastasis compared with patients with tumor in other locations (OR = 2.874, 95% CI 1.916–4.310; P = 0.001). Multifocality and extrathyroidal extension indicated a twofold higher risk of LLN metastasis. Having ≥ 2 CLN metastases dramatically increased the risk of LLN metastasis, compared with those with < 2 CLN metastases (OR = 6.536, 95% CI 4.630–9.259; P = 0.001).ConclusionsLarge tumor size (> 20 mm), tumor located in the upper lobe, multifocality, extrathyroidal extension, and ≥ 2 CLN metastases may increase the risk of LLN metastasis in cN0 PTC patients.
Highlights
Cervical lymph node metastasis of papillary thyroid carcinoma (PTC) is common
Large tumor size (> 20 mm) was observed with a fourfold higher risk of lateral lymph node (LLN) metastasis compared with small tumor size (≤ 20 mm; OR = 4.082, 95% CI 2.646–6.289; P = 0.001)
Our study indicates that large tumor size, tumor in the upper lobe, multifocality, ETE, and having ≥ 2 central lymph node (CLN) metastases were all associated positively with risk of LLN metastasis
Summary
Cervical lymph node metastasis of papillary thyroid carcinoma (PTC) is common. Whether undergoing prophylactic central lymph node (CLN) dissection or lateral lymph node (LLN) dissections to prevent metastasis is still controversial. 20–90% of PTC patients developed lymph node metastasis according to previous studies [5, 6]. These studies indicate that lymph node metastasis predicts a higher recurrence rate. The surgical treatment for metastasis of PTC remains controversial, especially the application of total thyroidectomy or lobectomy [8], and the prophylactic dissections of central and lateral lymph nodes (CLN and LLN, respectively) are debatable [9]
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