Abstract
IntroductionTo assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma).Materials and MethodsA total of 669 patients with a single nodule of isthmic PTC were retrospectively reviewed. The propensity score matching was performed twice separately. 176 patients respectively from patients who underwent thyroidectomy plus bilateral central lymph node dissection (BCLND) and who underwent thyroidectomy plus unilateral central lymph node dissection (UCLND) were matched. 77 patients were respectively selected from patients who underwent thyroidectomy plus BCLND and who underwent thyroidectomy with no central lymph node dissection (NCLND) were matched.ResultsAmong all the patients who underwent BCLND, 81/177 (45.76%) was confirmed with histologically positive CLN metastasis, and the occult lymph node metastasis is 25.42%. A tumor size of 1.05 cm was calculated as the cutoff point for predicting CLN metastasis by ROC curve analysis with 177 patients who underwent BCLND. The 5-year recurrence-free survival (RFS) rates were 92.9% in the NCLND group and 100% in the BCLND group with P<0.05, while there was no statistical difference in 5-year RFS between the BCLND group and UCLND group (P=0.11). The multivariate logistic regression analysis identified that age<55, tumor size>1cm, capsule invasion and lymphovascular invasion were significantly associated with CLN metastasis, while only age and lymphovascular invasion were proved to be independent risk factors related to contralateral CLN metastasis.ConclusionsThe thyroidectomy with NCLND could be insufficient for patients with isthmic PTC especially for those patients with high risk of central lymph node metastasis, considering that the rate of occult lymph node metastasis could not be ignored.
Highlights
To assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic Papillary thyroid carcinoma (PTC)
A total thyroidectomy was recommended for patients with a single tumor nodule if the tumor diameter is larger than 4cm, or with extrathyroidal extension, known distant metastases or cervical lymph node metastases, or prior radiation exposure according to the National Comprehensive Cancer Network (NCCN) guideline [10]
All of the patients involved in the study underwent thyroidectomy, including total thyroidectomy, lobectomy + isthmusectomy, or isthmusectomy. 51 patients were excluded for undergoing lateral neck lymph node dissection, 3 patients were excluded for losing follow-up
Summary
To assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma). High frequency of cervical lymph node metastasis had been regarded as the characteristic of PTC, which could be associated with the local recurrence and distant metastasis [4, 5]. A series of studies have associated isthmic PTC with multiple foci, local invasion to adjacent tissues and the high rate of bilateral CLN metastasis [9]. In the present study, we aim to assess the risk factor for the CLN metastasis and investigate the surgery extent of lymph nodes dissection for patients with PTC arising from isthmus
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