Risk factors for recurrence of papillary thyroid carcinoma with clinically node-positive lateral neck.

Abstract

BACKGROUND:

Papillary thyroid carcinoma (PTC) with clinically node-positive lateral neck is more likely to recur after surgery than node-negative PTC. The present study investigated the risk factors for recurrence in PTC patients with clinically node-positive lateral neck.

MATERIALS AND METHODS:

This study involved 136 patients with pathologically confirmed PTC and a clinically lymph node (LN)-positive lateral neck but no initial distant metastasis who underwent total thyroidectomy with therapeutic central and lateral neck dissection. Clinicopathologic characteristics, intraoperative findings, postoperative thyroglobulin (Tg) levels, and post-treatment recurrences were examined. Univariate and multivariate analyses were performed to identify factors associated with recurrence-free survival (RFS).

RESULTS:

During a median follow-up of 62 months (range 33-90 months), 27 (19.9 %) patients had locoregional or distant recurrences. Univariate analyses showed that primary tumor size (p = 0.049), recurrent laryngeal nerve invasion (p = 0.035), the maximal size of metastatic LN foci (≥1.5 cm; p = 0.012), extranodal extension (p = 0.025), total LN ratio (≥0.26; p = 0.008), American Thyroid Association (ATA) risk categories (p < 0.001), and stimulated serum Tg level (≥4.4; p < 0.001) at the time of radioactive iodine ablation therapy just after thyroidectomy were significant predictors of RFS. Multivariate analyses showed that the maximal size of metastatic foci (p = 0.037), ATA risk categories (p < 0.001), and stimulated Tg level (p < 0.001) were independent predictors of RFS.

CONCLUSIONS:

Maximal size of metastatic foci, ATA risk categories, and stimulated serum Tg levels are predictive of recurrence after surgery. Careful follow-up of patients with these risk factors is therefore recommended.

• Authors: Chang Wook Lee, Jong-Lyel Roh, Gyungyup Gong, Kyung-Ja Cho, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 22 Issue 1 Pg. 117-24 (Jan 2015) ISSN: 1534-4681 [Electronic] United States
• PMID: 25034816 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Papillary (secondary, surgery)
• Child
• Female
• Follow-Up Studies
• Humans
• Lymph Nodes (pathology, surgery)
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (pathology, surgery)
• Neoplasm Staging
• Postoperative Complications
• Prognosis
• Risk Factors
• Survival Rate
• Thyroid Neoplasms (pathology, surgery)
• Thyroidectomy
• Young Adult