Clinical Analysis of Cervical Lymph Node Metastasis Risk Factors and the Feasibility of Prophylactic Central Lymph Node Dissection in Papillary Thyroid Carcinoma

Objective. To identify the risk factors for cervical lymph node metastasis (CLNM) and the feasibility of prophylactic central lymph node dissection. Methods. The characteristics of 1107 patients were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with lymph node metastasis. The relationship between the central lymph node dissection (CLND) and lateral lymph node metastasis (LLNM) was analyzed using the correlation analysis. Results. The probability of CLNM was closely related to the male gender, age <55, and the increase of tumor size. Those patients with an increase in tumor size and CLNM were extremely prone to LLNM. Also, LLNM was more likely to happen in those with the more positive central lymph nodes. Routine prophylactic central lymph node dissection (P-CLND) did not increase the risk of complications. Conclusion. P-CLND should be considered as a reasonable surgical treatment for PTC.

Download Full-text

Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.620147 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yanjie Shuai ◽

Kai Yue ◽

Yuansheng Duan ◽

Mengqian Zhou ◽

Yan Fang ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Dissection ◽

Lymphovascular Invasion ◽

Papillary Thyroid ◽

Node Dissection ◽

Central Lymph Node ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

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.

Download Full-text

Meta-analysis of risk factors for CCLNM in patients with unilateral cN0 PTC

Endocrine Connections ◽

10.1530/ec-20-0058 ◽

2020 ◽

Vol 9 (5) ◽

pp. 387-395

Author(s):

Wei Sun ◽

Boyuan Zheng ◽

Zhihong Wang ◽

Wenwu Dong ◽

Yuan Qin ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Dissection ◽

Meta Analysis ◽

Central Lymph Node Metastasis ◽

Node Dissection ◽

Central Lymph Node ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

Summary Background In patients with papillary thyroid cancer (PTC) with clinical negative central lymph nodes (cN0), the use of prophylactic central lymph node dissection remains controversial. Contralateral central lymph node metastasis (CCLNM) occurs in 3.88–30.63% of patients with cN0 PTC. Therefore, the present meta-analysis aimed to obtain evidence for CCLNM risk factors in unilateral cN0 PTC. Materials and methods Relevant studies were identified in the PubMed, SCIE, and Wanfang databases up to Oct 31, 2019. The included patients had undergone lobectomy or total thyroidectomy with bilateral central lymph node dissection and were diagnosed pathologically with PTC. Revman 5.3 software was applied for statistical analysis. Results Thirteen studies comprising 2449 patients were included. The factors associated with increased CCLNM risk in patients with cN0 disease were: age <45 years (odds ratio (OR) = 1.89, 95% CI = 1.43–2.49, P < 0.00001), male sex (OR = 1.67, 95% CI = 1.24–2.24, P = 0.0007), extrathyroidal extension (OR = 1.63; 95% CI = 1.17–2.28; P = 0.004), tumor size ≥1 cm (OR = 2.63, 95% CI 1.85–3.74, P < 0.00001), lymphovascular invasion (OR = 4.27, 95% CI = 2.47–7.37, P < 0.00001), and ipsilateral central lymph node metastasis (OR = 11.42, 95% CI = 5.25–24.86, P < 0.00001). However, no association was found for capsular invasion, multifocality, or Hashimoto thyroiditis. Conclusion The meta-analysis identified that age <45 years, tumor ≥1 cm, male sex, lymphovascular invasion, extrathyroidal extension, and ipsilateral central lymph node metastasis are related to CCLNM in patients with unilateral CN0 PTC. These factors should influence the use of prophylactic central lymph node dissection in this group of patients.

Download Full-text

Risk factors for central neck lymph node metastases in papillary thyroid microcarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17583 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17583-e17583

Author(s):

Weihui Zheng ◽

Jinbiao Shang

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Node Dissection ◽

Univariate Analysis ◽

Node Dissection ◽

Central Lymph Node ◽

Neck Lymph Node ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

e17583 Background: Papillary thyroid microcarcinoma (PTMC) accounts for nearly half of all cases of thyroid papillary cancer. Although PTMC has a good prognosis, lymph node metastasis, especially central lymph node metastasis (CLNM), is the leading cause of local recurrence. The value of central lymph node dissection in PTMC remains controversial. Few studies have focused on the relationship between CLNM and multifocality in PTMC. This retrospective study of a large cohort of patients with PTMC aimed to identify assess the predictive value of multifocality for identifying patients at high risk of CLNM who may benefit from central lymph node dissection. Methods: Patients with PTMC who underwent total or hemi-thyroidectomy with effective unilateral or bilateral central lymph node dissection at Zhejiang Caner Hospital between January 2007 and December 2015 were enrolled ( n = 3543). Number and laterality of PTMC foci, extrathyroidal extension (ETE), tumor size, age, sex, positive/total number of central lymph nodes and other clinicopathological factors were recorded. The chi-square test was used for univariate analysis; logistic regression, for multivariate analysis. Results: Multifocality, age, sex, tumor size, ETE and nodular goiter were significantly associated with central lymph node metastasis (CLNM) in univariate analysis. Multifocality was an independent predictive factor for CLNM in multivariate analysis. Compared to unifocal disease, the odds ratio (OR) for CLNM was 1.447 for patients with ¡Ý 2 tumor foci ( P < 0.001) and 2.978 for patients with ¡Ý 3 tumor foci ( P < 0.001). Conclusions: Multifocality with ¡Ý 3 tumor foci was an independent predictive factor for CLNM in PTMC. Multifocality should be assessed when selecting patients for prophylactic central neck lymph node dissection, and we recommend patients with multifocality should undergo more radical treatment.

Download Full-text

Prophylactic Bilateral Central Neck Dissection Should Be Evaluated Based on Prospective Study of 581 PTC Patients

10.21203/rs.3.rs-672043/v1 ◽

2021 ◽

Author(s):

Shouyi YAN ◽

Jiafan Yu ◽

wenxin zhao ◽

Bo WANG ◽

Liyong ZHANG

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Test Group ◽

Control Group ◽

Node Dissection ◽

Central Lymph Node ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

Abstract Background: Prophylactic central lymph node dissection (PCND) had been a basic consensus for patients with papillary thyroid carcinoma in China. However, unilateral or bilateral central lymph node dissection (CND)was still controversial. This study aimed at investigating the safety and long-term benefit for the patients with bilateral central lymph node dissection (BCCD). Methods: 581 patients were enrolled and divided randomly into the test and control groups according to a different range of CND. 285 patients were prospectively assigned to undergo lobe thyroidectomy plus BCND in the test group, in comparison 296 patients were assigned to undergo lobe thyroidectomy plus ipsilateral central lymph node dissection (ICND) in the control group. Results: We found that the numbers of total LN and N1a in the test group were higher than that of the control group (p=0.002), but there was no difference in the number of metastasized lymph nodes (p=0.857) and tumor recurrence (p=0.308). Additionally, in the aspect of postoperative complication (1 day after surgery), the serum levels of parathyroid hormone in the BCND group were lower than that in the ICND group (P =0.010), and the numbers of transient laryngeal nerve palsy were higher than that(p=0.033). meanwhile we further found that tumors size larger than 1cm and tumor side lymph node metastasis were related to the contralateral lymph node metastasis. Conclusion: BCND resulted in more positive lymph nodes and complications while did not change the patient's long-term prognosis. It may be an alternative for patients with tumor sizes larger than 1cm in large medical centers.

Download Full-text

Risk factors of hypoparathyroidism following total thyroidectomy with central lymph node dissection

Medicine ◽

10.1097/md.0000000000008162 ◽

2017 ◽

Vol 96 (39) ◽

pp. e8162 ◽

Cited By ~ 9

Author(s):

Anping Su ◽

Bin Wang ◽

Yanping Gong ◽

Rixiang Gong ◽

Zhihui Li ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Total Thyroidectomy ◽

Lymph Node Dissection ◽

Node Dissection ◽

Central Lymph Node ◽

Central Lymph Node Dissection ◽

Central Lymph

Download Full-text

Prophylactic Bilateral Central Neck Dissection Should Be Carefully Evaluated Based on Prospective Study of 581 Cases With cN0 Papillary Thyroid Carcinoma

10.21203/rs.3.rs-191568/v1 ◽

2021 ◽

Author(s):

Shouyi Yan ◽

Wen Xin Zhao ◽

Bo Wang ◽

Liyong Zhang

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Test Group ◽

Control Group ◽

Node Dissection ◽

Central Lymph Node ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

Abstract Background: prophylactic central lymph node dissection (PCND) had been a basic consensus for patients with papillary thyroid carcinoma (PTC) in China. However, unilateral or bilateral central lymph node dissection (CND)was still controversial. This study aimed at investigating the safety and long-term benefit for the patients with bilateral central lymph node dissection (BCCD). Methods: 581 patients were enrolled and divided randomly into the test and control groups according to a different range of CND. 285 patients were prospectively assigned to undergo lobe thyroidectomy plus BCND in the test group, in comparison 296 patients were assigned to undergo lobe thyroidectomy plus ipsilateral central lymph node dissection (ICND) in the control group. Results: We found that the numbers of total LN and N1a in the test group were higher than that of the control group (p = 0.002), but there was no difference in the number of metastasized lymph nodes (p = 0.857) and tumor recurrence (p = 0.308). Additionally, in the aspect of postoperative complication (1 day after surgery), the serum levels of parathyroid hormone in the BCND group were lower than that in the ICND group (P = 0.010), and the numbers of transient laryngeal nerve palsy were higher than that(p = 0.033). meanwhile we further found that tumors size larger than 1cm and tumor side lymph node metastasis were related to the contralateral lymph node metastasis. Conclusion: BCND resulted in more positive lymph nodes and similar surgical complications compared with ICND but did not change the patient's long-term prognosis. It may be an alternative for patients with tumor sizes larger than 1cm. Meanwhile, and it should be done in large medical centers, with rich experience in PG and RLN protection

Download Full-text

2108 cases of thyroid cancer cervical lymph node dissection or not

10.21203/rs.2.14929/v1 ◽

2019 ◽

Author(s):

Lin Han ◽

Zhen Wu ◽

Wenlei Li ◽

Yingxue Li ◽

Jinglin Ma ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Tumor Diameter ◽

Node Dissection ◽

Central Lymph Node ◽

Lateral Lymph Node ◽

Cervical Lymph Nodes ◽

Central Lymph Node Dissection ◽

Node Metastasis ◽

Central Lymph

Abstract Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them,There were 1001 cases underwent open operation with total thyroidectomy + central lymph node dissection, meanwhile 1107 cases were treated with neck lateral lymph node dissection at the same time.The overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of PTMC was as high as 48.97%. When the mass rose above 2cm, the proportion of metastasis increased to 77.22%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation.When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.When the tumor diameter exceeds 1cm, the risk of cervical lymph node metastasis is high, we recommended the lateral lymph node dissection.

Download Full-text