Abstract
IntroductionLymph node (LN) metastasis is the first site of metastasis of papillary thyroid cancer (PTC). LN status influences clinical management and the prognosis of patients. We explored the relationship between patient obesity and regional patterns of LN involvement in PTC.Materials and MethodsThis study retrospectively analyzed the data from 12,772 PTC patients. The rate of LN metastasis, number of LN metastasis, maximum diameter of positive LN, number of dissected LN, and LN ratios (LNR) were compared between normal-weight and obese patients. Statistical methods have been adjusted for the confounders in hypothesis testing.ResultsOverweight and obesity were independent risk factor for metastatic LNs (OR1 = 1.125, 95% CI 1.042-1.214, P1 = 0.003; OR2 = 1.554, 95% CI 1.339-1.802, P2 <0.001). Obesity was an independent risk factor for the number of metastatic CLNs (OR=1.159, 95% CI 0.975-1.377, P=0.045), however not for number of metastatic lateral LNs (P=0.907). Furthermore, obesity was not an independent risk factor for number of CLNs when dissected more than five (P=0.653), still an independent risk factors for number of metastatic lateral LNs when more than six (OR=1.185, 95% CI 1.010-1.391, P=0.037). As for LNR, obesity was an independent risk factor for the central LNR when more than 0.12 (OR adjusted 1 = 1.099, 95% CI 1.011-1.194, P1 = 0.027; OR adjusted 2 = 1.177, 95% CI 1.003-1.381, P2 = 0.045), for the lateral LNR more than 0.05 (P2 = 0.283).ConclusionsObesity was associated with poor prognoses with PTC respecting LNs. Surgeons should be extreme caution when performing central neck dissection in obese patients.
Highlights
Lymph node (LN) metastasis is the first site of metastasis of papillary thyroid cancer (PTC)
As for lymph node ratio (LNR), obesity was an independent risk factor for the central LNR when more than 0.12 (OR adjusted 1 = 1.099, 95% confidence interval (CI) 1.011-1.194, P1 = 0.027; OR adjusted 2 = 1.177, 95% CI 1.003-1.381, P2 = 0.045), for the lateral LNR more than 0.05 (P2 = 0.283)
Obesity was associated with poor prognoses with PTC respecting LNs
Summary
Lymph node (LN) metastasis is the first site of metastasis of papillary thyroid cancer (PTC). We explored the relationship between patient obesity and regional patterns of LN involvement in PTC. Obesity has been identified as an independent risk factor for many cancers. Obesity has been linked to an increased risk of diabetes and coronary artery disease, the impact of obesity on the incidence rates, risk factors, morbidity, and mortality of thyroid cancer requires further exploration [4]. Obesity affects the diagnostic assessment of patients negatively. Deglise et al found that obese women were less likely to have undergone ultrasound (OR=0.5) or MRI (OR= 0.3) and were at an increased risk of prolonged hospital stays (OR=4.7) in the clinic [6]
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