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Mardani P, Koulaian S, Fouladi D, Rajaie Ramsheh FS, Amirian A, Shahriarirad S, Malekhosseini SA, Shahriarirad R. Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross-sectional study. Health Sci Rep 2024; 7:e2012. [PMID: 38567186 PMCID: PMC10985224 DOI: 10.1002/hsr2.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aims The incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery. Methods This cross-sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015-2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software. Results A total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001). Conclusion Our study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high-risk populations.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Shiraz Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Sepehr Koulaian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Damoun Fouladi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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Weitzman RE, Justicz NS, Kamani D, Kyriazidis N, Chen MH, Randolph GW. How Many Nodes to Take? Lymph Node Ratio Below 1/3 Reduces Papillary Thyroid Cancer Nodal Recurrence. Laryngoscope 2022; 132:1883-1887. [PMID: 35229306 DOI: 10.1002/lary.30084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 02/02/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid malignancies; risk of PTC recurrence over a 30-year period is approximately 30%, of which 70% occur as nodal metastases. Patients with nodal disease who are treated with therapeutic dissection are at higher risk for recurrence, but optimal nodal yield has not been defined. We aim to determine variables predictive of nodal recurrence of PTC within the first 5 years of surgery, with a focus on lymph node ratio (LNR), to inform clinical decision-making. METHODS Retrospective chart review identified 41 patients with nodal recurrence of PTC and 284 without nodal recurrence following thyroid surgery from 2000 to 2015. Cohorts were compared with regards to clinical history, surgical findings, and tumor characteristics. RESULTS The fraction of the patients who underwent therapeutic central or lateral lymph node dissection was significantly higher in the nodal recurrence cohort. Maximum tumor size, presence of extrathyroidal extension, largest lymph node focus, LNR, postoperative thyroglobulin level, and administration of postoperative radioactive iodine were significantly increased in the PTC nodal recurrence group. LNR greater than 0.3 held the highest level of significance as a binary cutoff and captured the larger proportion of patients in the nodal recurrence cohort (68.3%). CONCLUSION This study demonstrates characteristics to help assess risk of nodal recurrence of PTC and suggests LNR of lower than 0.3 is optimal to reduce risk of recurrence. The next steps include cohort studies to validate findings and weight variable analysis to optimize the extent of surgical therapeutic dissection. LEVEL OF EVIDENCE 4 Laryngoscope, 132:1883-1887, 2022.
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Affiliation(s)
- Rachel E Weitzman
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Natalie S Justicz
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Dipti Kamani
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Natalia Kyriazidis
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ming-Hsu Chen
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Dong W, Horiuchi K, Noguchi E, Okamoto T. Predictive value of metastatic lateral lymph node ratio for recurrence in pathologically lateral lymph node-positive papillary thyroid cancer patients with palpable lymph nodes. Head Neck 2022; 44:1623-1630. [PMID: 35452140 DOI: 10.1002/hed.27067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aimed to identify the predictive value of the extent of metastatic lymph nodes in the central and lateral neck compartment for recurrence in papillary thyroid cancer (PTC) patients with pathologically lateral lymph node metastasis (pN1b). METHODS This study enrolled 252 patients with pN1b from PTC. RESULTS During a mean follow-up of 17.6 years, 55 (21.8%) patients experienced recurrence. Patients with palpable lymph nodes were more likely to have a recurrence than those with nonpalpable lymph nodes (30.1% vs. 17.8%, relative risk 1.7, 95%CI: 1.1-2.7). For patients with palpable metastatic lymph nodes, lymph node ratio of lateral lymph nodes ≥0.5 (aHR = 2.906, 95%CI: 1.29-6.54) and age ≥55 years (aHR = 2.508, 95%CI: 1.12-5.63) were independent prognostic factors. For those without palpable nodes, age ≥55 years (aHR = 2.224, 95%CI: 1.08-4.60) and tumor size >4 cm (aHR = 2.168, 95%CI: 1.01-4.66) were independently predictive of worse RFS. CONCLUSIONS Palpable lymph nodes were approximately twice as likely to recur as nonpalpable nodes. Metastatic lateral lymph node ratio predicts recurrence in pN1b PTC patients with palpable lymph nodes, but not those without ones.
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Affiliation(s)
- Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China.,Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyomi Horiuchi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiichiro Noguchi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Kim MJ, Kim HJ, Park CS, Kim BW. Frozen section analysis of central lymph nodes in papillary thyroid cancer: the significance in determining the extent of surgery. Gland Surg 2022; 11:640-650. [PMID: 35531106 PMCID: PMC9068541 DOI: 10.21037/gs-22-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/04/2022] [Indexed: 12/23/2023]
Abstract
BACKGROUND The indolent feature of papillary thyroid cancer (PTC) has recently led to an increase in less aggressive treatment options instead of total thyroidectomy (TT). We aimed to investigate the clinical significance of elective central compartment neck dissection (CCND) with intraoperative frozen analyses of the central lymph nodes (LNs) to determine the surgical extent of unilateral clinically node-negative PTC. METHODS We retrospectively reviewed the medical records of 290 patients with unilateral clinically node-negative PTC who underwent surgery and performed frozen analyses of the central LNs from 2020 to 2021 using our own nodal criteria with cut-off size 5 mm. The patients were divided and investigated according to the surgical extent and the National Comprehensive Cancer Network (NCCN) guidelines; diagnostic accuracy of the frozen analyses was estimated. RESULTS TT was performed in 16.2% of patients. The TT group had more metastatic nodes with a larger size, higher LN ratio (LNR), and more extranodal extension. The analyses based on the NCCN guidelines showed similar findings, but more completion TT was required compared with our criteria. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the frozen analyses were 94.6%, 100%, 100%, and 96.1%, respectively. CONCLUSIONS Elective CCND with intraoperative frozen analyses is a highly reliable procedure that detects occult nodal metastasis in unilateral node-negative PTC patients. Our nodal criteria yielded significant aggressive nodal characteristics in the TT group while yielding less TTs compared with the NCCN guidelines. The concept and clinical significance of small-volume nodal metastasis in PTC should be further investigated.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Hee Jun Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
| | - Bup-Woo Kim
- Department of Surgery, CHA Ilsan Medical Center, Cha University School of Medicine, Goyang-si, South Korea
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Parvathareddy SK, Siraj AK, Qadri Z, Ahmed SO, DeVera F, Al-Sobhi S, Al-Dayel F, Al-Kuraya KS. Lymph node ratio is superior to AJCC N stage for predicting recurrence in papillary thyroid carcinoma. Endocr Connect 2022; 11:e210518. [PMID: 35044932 PMCID: PMC8859938 DOI: 10.1530/ec-21-0518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recently, lymph node ratio (LNR) has emerged as an alternative to American Joint Committee on Cancer (AJCC) N stage, with superior prognostic value. The utility of LNR in Middle Eastern papillary thyroid carcinoma (PTC) remains unknown. Therefore, we retrospectively analyzed a large cohort of 1407 PTC patients for clinicopathological associations of LNR. METHODS Receiver operating characteristics (ROC) curve was used to determine the cut-off for LNR. We also performed multivariate logistic regression analysis to determine whether LNR or AJCC N stage was superior in predicting recurrence in PTC. RESULTS Based on ROC curve analysis, a cut-off of 0.15 was chosen for LNR. High LNR was significantly associated with adverse clinicopathological characteristics such as male sex, extrathyroidal extension, lymphovascular invasion, multifocality, bilateral tumors, T4 tumors, lateral lymph node (N1b) involvement, distant metastasis, advanced tumor stage, American Thyroid Association (ATA) high-risk category and tumor recurrence. On multivariate analysis, we found that LNR was a better predictor of tumor recurrence than AJCC N stage (odds ratio: 1.96 vs 1.30; P value: 0.0184 vs 0.3831). We also found that LNR combined with TNM stage and ATA risk category improved the prediction of recurrence-free survival, compared to TNM stage or ATA risk category alone. CONCLUSIONS The present study suggests LNR is an independent predictor of recurrence in Middle Eastern PTC. Integration of LNR with 8th edition AJCC TNM staging system and ATA risk stratification will improve the accuracy to predict recurrence in Middle Eastern PTC and help in tailoring treatment and surveillance strategies in these patients.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeeda O Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felisa DeVera
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Ho AS, Luu M, Shafqat I, Mallen-St Clair J, Chen MM, Chen Y, Jain M, Ali N, Patio C, Filarski CF, Lin DC, Bankston H, Braunstein GD, Sacks WL, Zumsteg ZS. Predictive Impact of Metastatic Lymph Node Burden on Distant Metastasis Across Papillary Thyroid Cancer Variants. Thyroid 2021; 31:1549-1557. [PMID: 34470466 DOI: 10.1089/thy.2021.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: While numerous factors determine prognosis in papillary thyroid carcinoma (PTC), distant metastasis (M1) represents one of the most dire. Escalating nodal burden and aggressive histology may contribute to higher metastatic risk, but this relationship is poorly defined and challenging to anticipate. We evaluate the predictive impact of these histological features on predicting distant metastases at initial presentation. Methods: Univariate and multivariable logistic regression models of conventional and aggressive thyroid cancer variants (well-differentiated papillary thyroid carcinoma [WDPTC], diffuse sclerosing variant [DSV], tall cell variant [TCV], poorly differentiated thyroid cancer [PDTC], and anaplastic thyroid carcinoma [ATC]) identified via U.S. cancer registry data were constructed to determine associations between M1 status and quantitative nodal burden. Associations between metastatic lymph node (LN) number and M1 disease were modeled using univariate and multivariable logistic regression with interaction terms, as well as a linear continuous probability model. Results: Overall, M1 prevalence at disease presentation was 3.6% (n = 1717). When stratified by subtype, M1 prevalence varied significantly by histology (WDPTC [1.0%], DSV [2.3%], TCV [4.1%], PDTC [17.4%], ATC [38.4%] [p < 0.001]). For WDPTC, M1 prevalence escalated with metastatic LN number (0 LN+ [0.5%], 1-5 LN+ [2.0%], 6-10 LN+ [3.4%], >10 LN+ [5.5%] [p < 0.001]) and LN ratio (p < 0.001). A statistically significant interaction was observed between histology and increasing nodal burden for M1 risk. On multivariable analysis, each successive metastatic LN conferred increased M1 risk for WDPTC (odds ratio [OR] 1.06 [1.05-1.08], p < 0.001) and TCVs (OR 1.04 [1.02-1.07], p < 0.001). In contrast, other aggressive variants had a higher baseline M1 risk, but this did not vary based on the number of positive LN (DSV, OR 1.02 [0.95-1.10], p = 0.52; PDTC, OR 1.00 [0.98-1.02], p = 0.66; ATC, 1.00 [0.98-1.02], p = 0.97). Conclusions: Progressive nodal burden independently escalates the risk of distant metastasis in WDPTC and TCVs of PTC. Conversely, aggressive variants such as PDTC and ATC have substantial M1 risk at baseline and appear to be minimally affected by metastatic nodal burden. Consideration of these factors after surgery may help tailor clinical decision-making for treatment and surveillance. Further studies are warranted to calibrate the ideal management approach for these higher risk patient groups.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Iram Shafqat
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle M Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Monica Jain
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nabilah Ali
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chrysanta Patio
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carolyn F Filarski
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - De-Chen Lin
- Department of Medicine, and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hakimah Bankston
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Glenn D Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Iglesias C, González O, Temprana-Salvador J, García-Burillo A, Caubet E, Ramón Y Cajal S, Zafon C. Nodal metastatic load in papillary thyroid carcinoma. Morphological and molecular analysis with one-step nucleic acid amplification on more than 550 lymph nodes. ENDOCRINOL DIAB NUTR 2021; 68:346-353. [PMID: 34556265 DOI: 10.1016/j.endien.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE The risk of recurrence in papillary thyroid carcinoma (PTC) is likely related to the amount of tumour in the metastatic lymph node (LN). Therefore, the current TNM classification (N0/N1) make it necessary to find a method to quantify the LN metastasis (LNM). We propose that the quantitative molecular assay One-Step Nucleic-Acid Amplification (OSNA), which measures the number of cytokeratin-19 (CK-19) mRNA copies as a marker of LNM, could play this role. Our objective was to describe the characteristics of the LNs from PTC, and to compare the morphological characteristics that have been claimed as criteria for metastatic burden with OSNA. PATIENTS AND METHOD Prospective study of LNs from 42 patients. All of the LNs were measured, weighed and analysed by OSNA and also by imprint cytology. RESULTS A total of 573 LNs were included, 187 (32.6%) of them were OSNA-positives. The global consistency between cytology and OSNA was 87.4%. Significant differences were observed in the CK-19 copy number between the LNMs<0.2cm and those >3cm, as well as between those from 0.2 to 3cm with respect to those >3cm, but not between those <0.2cm and those between 0.2 and 3cm. The total tumour load per neck dissection showed no differences based on whether there were ≤5 or >5 LNMs. CONCLUSIONS In our series the LNMs >3cm show an increased tumour load, but it is unclear if it is necessary to sub-classify the smaller ones as well as the relevance of the number of metastatic nodes according to the cut-off of 5 nodes. We consider that the OSNA analysis avoids the bias of nodal histology and allows for a greater understanding of its real oncological potential.
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Affiliation(s)
- Carmela Iglesias
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain; Translational Molecular Pathology Research Group (VHIR), Hospital Vall d'Hebron, 119-129 Passeig Vall d'Hebron, Barcelona, Spain.
| | - Oscar González
- Department of General Surgery, Endocrine Surgery Division, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Jordi Temprana-Salvador
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Amparo García-Burillo
- Department of Nuclear Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Enric Caubet
- Department of General Surgery, Endocrine Surgery Division, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Santiago Ramón Y Cajal
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain; Translational Molecular Pathology Research Group (VHIR), Hospital Vall d'Hebron, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Carles Zafon
- Department of Endocrinology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
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8
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Karvounis E, Kappas I, Angelousi A, Makris GM, Siamatras TD, Kassi E. The diagnostic and predictive accuracy of thyroglobulin to TSH ratio and TSH to thyroglobulin ratio in detecting differentiated thyroid carcinoma in normothyroid patients with thyroid nodules: A retrospective cohort study and systematic review of the literature. Oncol Rev 2021; 14:439. [PMID: 33505608 PMCID: PMC7814274 DOI: 10.4081/oncol.2020.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of the present study is to examine the diagnostic and predictive accuracy of the thyroglobulin (Tg) to thyroid stimulating hormone (TSH) and TSH/Tg ratios in normothyroid patients with differentiated thyroid cancer (DTC). We conducted a retrospective cohort study evaluating the diagnostic accuracy of the serum Tg/TSH and TSH/Tg ratios in normothyroid patients with thyroid nodules. We also systematically searched the international literature using the Medline, Cochrane's CENTRAL, Scopus, Clinicaltrials.gov, EMBASE, and Google Scholar databases for evidence concerning the diagnostic and predictive accuracy of these ratios. Overall, 374 patients were identified in our cohort study of whom 240 were treated for benign disease and 134 were treated for DTC. Significant differences were noted in the Tg/TSH and TSH/Tg values among cases with malignant and benign disease (P=0.020). However, the diagnostic ROC curve did not confirm these results (Tg/TSH=0.572 and TSH/Tg=0.428). After searching the international literature, we identified 8 studies. The majority of the included data reported significant differences among patients with benign/malignant disease and those with successful iodine therapy compared to those with disease relapse. However, the clinical relevance was clearer among studies that investigated the usefulness of these ratios in predicting recurrent disease. The findings of our study support that the Tg/TSH ratio increases in patients with DTC and can, thus, become useful in the future as a predictive marker of ablative 131I therapy success. However, given the significant variability of Tg its diagnostic accuracy remains to date minimal; thus, the actual cut-off value that can be used to discriminate cancer cases from benign disease has not been determined yet.
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Affiliation(s)
- Evangelos Karvounis
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Ioannis Kappas
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Anna Angelousi
- Department of Internal Medicine, Laiko hospital, National and Kapodistrian University of Athens
| | | | - Thomas D Siamatras
- Department of Endocrine Surgery Center of Excellence, Euroclinic Hospital, Athens
| | - Eva Kassi
- Department of Internal Medicine, Laiko hospital, National and Kapodistrian University of Athens.,Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Iglesias C, González O, Temprana-Salvador J, García-Burillo A, Caubet E, Ramón Y Cajal S, Zafon C. Nodal metastatic load in papillary thyroid carcinoma. Morphological and molecular analysis with one-step nucleic acid amplification on more than 550 lymph nodes. ACTA ACUST UNITED AC 2020; 68:346-353. [PMID: 32800751 DOI: 10.1016/j.endinu.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The risk of recurrence in papillary thyroid carcinoma (PTC) is likely related to the amount of tumour in the metastatic lymph node (LN). Therefore, the current TNM classification (N0/N1) make it necessary to find a method to quantify the LN metastasis (LNM). We propose that the quantitative molecular assay One-Step Nucleic-Acid Amplification (OSNA), which measures the number of cytokeratin-19 (CK-19) mRNA copies as a marker of LNM, could play this role. Our objective was to describe the characteristics of the LNs from PTC, and to compare the morphological characteristics that have been claimed as criteria for metastatic burden with OSNA. PATIENTS AND METHOD Prospective study of LNs from 42 patients. All of the LNs were measured, weighed and analysed by OSNA and also by imprint cytology. RESULTS A total of 573 LNs were included, 187 (32.6%) of them were OSNA-positives. The global consistency between cytology and OSNA was 87.4%. Significant differences were observed in the CK-19 copy number between the LNMs<0.2cm and those >3cm, as well as between those from 0.2 to 3cm with respect to those >3cm, but not between those <0.2cm and those between 0.2 and 3cm. The total tumour load per neck dissection showed no differences based on whether there were ≤5 or >5 LNMs. CONCLUSIONS In our series the LNMs >3cm show an increased tumour load, but it is unclear if it is necessary to sub-classify the smaller ones as well as the relevance of the number of metastatic nodes according to the cut-off of 5 nodes. We consider that the OSNA analysis avoids the bias of nodal histology and allows for a greater understanding of its real oncological potential.
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Affiliation(s)
- Carmela Iglesias
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain; Translational Molecular Pathology Research Group (VHIR), Hospital Vall d'Hebron, 119-129 Passeig Vall d'Hebron, Barcelona, Spain.
| | - Oscar González
- Department of General Surgery, Endocrine Surgery Division, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Jordi Temprana-Salvador
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Amparo García-Burillo
- Department of Nuclear Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Enric Caubet
- Department of General Surgery, Endocrine Surgery Division, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Santiago Ramón Y Cajal
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain; Translational Molecular Pathology Research Group (VHIR), Hospital Vall d'Hebron, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
| | - Carles Zafon
- Department of Endocrinology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, 119-129 Passeig Vall d'Hebron, Barcelona, Spain
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10
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Deligiorgi MV, Panayiotidis MI, Trafalis DT. Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment. Per Med 2020; 17:317-338. [PMID: 32588744 DOI: 10.2217/pme-2019-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Considering the 'differentiated thyroid carcinoma (DTC) epidemic', the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20-90% of DTC, are the main culprit of recurrent disease, affecting 5-30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.
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Affiliation(s)
- Maria V Deligiorgi
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
| | - Mihalis I Panayiotidis
- Department of Applied Sciences, Group of Translational Biosciences, Faculty of Health & Life Sciences, Northumbria University, Ellison Building A516, Newcastle Upon Tyne, NE1 8ST, UK.,Department of Electron Microscopy & Molecular Pathology, Cyprus Institute of Neurology & Genetics, 1683 Nicosia, Cyprus
| | - Dimitrios T Trafalis
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
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11
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Noel JE, Orloff LA. Recognizing Persistent Disease in Well-Differentiated Thyroid Cancer and Association with Lymph Node Yield and Ratio. Otolaryngol Head Neck Surg 2019; 162:50-55. [PMID: 31661359 DOI: 10.1177/0194599819886123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To establish the association between lymph node yield and ratio in neck dissection for well-differentiated thyroid cancer and risk for persistent postoperative disease. STUDY DESIGN Retrospective cohort study of patients undergoing lymphadenectomy for thyroid carcinoma. SETTING Tertiary referral center. SUBJECTS AND METHODS Included patients underwent central and/or lateral neck dissection for papillary thyroid carcinoma at our institution between 1994 and 2015. They were divided into a persistent disease group with biochemical and structural disease (49 patients) and a disease-free group with no disease after a minimum 2 years of follow-up (175 patients). Demographic characteristics, adjuvant therapy, tumor, and lymph node features were compared. RESULTS There were no significant differences in demographic characteristics between the groups. The mean nodal yield of patients with central and lateral neck persistence was significantly lower than that of patients remaining disease free (4.8 vs. 11.9: odds ratio [OR] 0.69; 95% CI, 0.59 to 0.8; P < .001; 14.8 vs. 31.0: OR, 0.89; 95% CI, 0.84-0.94; P < .001, respectively). Nodal ratio was higher in patients with persistence in the central and lateral neck (74.2% vs 29.4%: OR, 1.06; 95% CI, 1.04-1.08; P < .001; 54.2% vs 19.8%: OR, 1.08; 95% CI, 1.04-1.12; P < .001, respectively). CONCLUSIONS Lower lymph node yield and higher node ratio from cervical lymph node dissections are associated with persistent disease and have potential applications in surgical adequacy.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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12
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Clinical Value of Lymph Node Ratio Integration with the 8 th Edition of the UICC TNM Classification and 2015 ATA Risk Stratification Systems for Recurrence Prediction in Papillary Thyroid Cancer. Sci Rep 2019; 9:13361. [PMID: 31527831 PMCID: PMC6746784 DOI: 10.1038/s41598-019-50069-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Recently, the 2015 American Thyroid Association (ATA) risk stratification and the 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system were released. This study was conducted to assess the clinical value of the lymph node ratio (LNR) as a predictor of recurrence when integrated with these newly released stratification systems, and to compare the predictive accuracy of the modified systems with that of the newly released systems. The optimal LNR threshold value for predicting papillary thyroid cancer (PTC) recurrence was 0.17857 using the Contal and O'Quigley method. The 8th edition of the AJCC/UICC TNM staging system with the LNR and the 2015 ATA risk stratification system with the LNR were significant predictors of recurrence. Furthermore, calculation of the proportion of variance explained (PVE), the Akaike information criterion (AIC), Harrell's c index, and the incremental area under the curve (iAUC) revealed that the 8th edition of the TNM staging system with the LNR, and the 2015 ATA risk stratification system with the LNR, showed the best predictive performance. Integration of the LNR with the TNM staging and the ATA risk stratification systems should improve prediction of recurrence in patients with PTC.
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13
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Nie D, Mao X, Li Z. Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China. J Cancer 2019; 10:4689-4694. [PMID: 31528234 PMCID: PMC6746121 DOI: 10.7150/jca.29896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Ovarian clear cell carcinoma (OCCC) has a worse prognosis compared to other histological subtypes. Although the survival effect of lymph nodes ratio (LNR) on ovarian carcinoma have been elucidated in several studies, the prognostic effect of LNR in OCCC has not been separately studied. This study aimed to investigate the prognostic significance of LNR in FIGO stage III OCCC. Methods: Patients with FIGO stage III OCCC who underwent primary cytoreductive surgery and systematic lymphadenectomy from January 2008 to June 2014 in two independent hospitals were retrospectively reviewed. Two independent patients cohorts were used to investigate the survival impact of LNR by using Kaplan-Meier and Cox regression proportional hazard method. Results: In training cohort, the 5-year progression-free survival (PFS) rates was 32.4% for patients with LNR ≤ 25%, and 19.8% for patients with LNR > 25%, respectively (p = 0.017). The 5-year overall survival (OS) rates was 41.3% for patients with LNR ≤ 25%, and 25.8% for patients with LNR > 25%, respectively (p = 0.003). In multivariate analysis, increased LNR was correlated with a poorer DFS (HR = 2.12 ,95% CI 1.32-3.41, p = 0.002) and OS (HR = 2.29, 95% CI 1.37-5.12, p = 0.001). These results were verified in a validation cohort. Conclusions: LNR is an independent survival predictor in patients with FIGO stage III OCCC.
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Affiliation(s)
- Dan Nie
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu,610041, People's Republic of China.,Department of Obstetrics and Gynecology, The affiliated hospital of Southwest Medical University, Luzhou,646000, People's Republic of China
| | - Xiguang Mao
- Department of Obstetrics and Gynecology, The affiliated hospital of Southwest Medical University, Luzhou,646000, People's Republic of China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu,610041, People's Republic of China
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14
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Lee YM, Park JH, Cho JW, Hong SJ, Yoon JH. The definition of lymph node micrometastases in pathologic N1a papillary thyroid carcinoma should be revised. Surgery 2018; 165:652-656. [PMID: 30385127 DOI: 10.1016/j.surg.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to identify the risk factors for structural recurrence with a focus on lymph node-related factors and to determine the optimal cutoff size of lymph node micrometastases in patients with pathologic N1a classical papillary thyroid carcinoma. METHODS We included patients who underwent total thyroidectomy with central compartment lymph node dissection for classic papillary thyroid carcinoma with pathologic N1a classification. RESULTS A total of 398 patients were followed up for a median of 131 months. Structural recurrence occurred in 17.3% of patients (69/398). The multivariate analysis reported the following independent risk factors for structural recurrence: tumor size >1.95 cm, bilaterality, lymphatic and/or vascular invasion, a maximum diameter of the metastatic lymph node focus >3.5 mm, distribution of metastatic lymph node foci size >3.0 mm, and ≥4 metastatic lymph nodes. CONCLUSION The newly proposed cutoff of 3.5 mm for a definition of lymph node micrometastasis in pathologic N1a papillary thyroid carcinoma patients can reclassify the risk estimates of structural recurrence, thus modifying postoperative management plans and follow-up strategies.
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Affiliation(s)
- Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Ho Yoon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
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15
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Pyo JS, Sohn JH, Chang K. Prognostic Role of Metastatic Lymph Node Ratio in Papillary Thyroid Carcinoma. J Pathol Transl Med 2018; 52:331-338. [PMID: 30157618 PMCID: PMC6166020 DOI: 10.4132/jptm.2018.08.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis. Methods We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival. Results Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively). Conclusions Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungseek Chang
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Low-Dose Radioactive Iodine Ablation Is Sufficient in Patients With Small Papillary Thyroid Cancer Having Minor Extrathyroidal Extension and Central Lymph Node Metastasis (T3 N1a). Clin Nucl Med 2018; 42:842-846. [PMID: 28832376 DOI: 10.1097/rlu.0000000000001812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of low-dose radioactive iodine (RAI) ablation in patients with small papillary thyroid cancer (PTC) exhibiting microscopic extrathyroidal extension (mETE) and central lymph node (CLN) metastasis. METHODS Among patients who underwent RAI ablation between March 2007 and February 2014, those who had small PTCs (≤2 cm), as well as mETE and CLN metastasis (T3 N1a M0), were enrolled. Response to ablation and long-term outcomes were assessed and compared according to the administered RAI dose. Factors associated with unsuccessful ablation were also determined. RESULTS A total of 180 patients were included in the study. Eighty-eight patients had been treated with 1110 MBq (low-dose group) and 92 with 2960 MBq (high-dose group) of RAI. There were no significant differences in the responses to ablation (P = 0.810) and long-term outcomes (P = 0.663) between both groups. Among all patients enrolled, 13 did not achieve successful ablation at long-term follow-up. Logistic regression found that a high ratio of metastatic nodes was a significant factor for predicting unsuccessful ablation. CONCLUSIONS Low-dose RAI ablation did not produce significantly different responses or long-term outcomes in patients with small PTCs exhibiting mETE and CLN metastasis. These findings suggest that low-dose ablation may be sufficient in this specific group of intermediate-risk patients, although careful selection is required for patients with a high ratio of metastatic nodes.
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17
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Kim HI, Kim K, Park SY, Choe JH, Kim JH, Kim JS, Oh YL, Hahn SY, Shin JH, Ahn HS, Kim SW, Kim TH, Chung JH. Refining the eighth edition AJCC TNM classification and prognostic groups for papillary thyroid cancer with lateral nodal metastasis. Oral Oncol 2018; 78:80-86. [DOI: 10.1016/j.oraloncology.2018.01.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 02/08/2023]
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18
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Sapuppo G, Palermo F, Russo M, Tavarelli M, Masucci R, Squatrito S, Vigneri R, Pellegriti G. Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome. J Endocrinol Invest 2017. [PMID: 28646475 DOI: 10.1007/s40618-017-0714-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC), the most common thyroid cancer histotype, has a good prognosis even when spread to the neck lymph node (LN). The prognostic role of LN metastases' location is still controversial. The aim of the present study was to evaluate the clinical relevance of the number and location of LN metastases at presentation in PTCs. METHODS This retrospective study included a consecutive series of 1653 PTC patients followed for a mean period of 5.9 years in a referral thyroid cancer clinic. All patients have undergone thyroidectomy with the dissection of at least six LNs. According to the LN status, patients were subdivided into 569 N0 (34.4%), 644 N1a (39.0%, central compartment) and 440 N1b (26.6%, latero-cervical compartment). RESULTS Age at diagnosis was significantly lower in N1b (39.8, IQR 30.7-51.6) and N1a (40.1, IQR 31.3-50.1) than in N0 (44.7, IQR 36.6-55.0 yrs). The male gender was more prevalent in N1b than in N1a and N0 (F/M = 1.9/1, 4.0/1 and 5.5/1, respectively). Persistent/recurrent disease at last control was significantly more frequent in N1b (29.8%) than in N1a (14.3%), and in N1a than in N0 (4.2%) (p < 0.01 for all). Also, distant metastases were significantly (p < 0.001) more frequent in N1b (14.1%) than in N1a (4.3%) and N0 (1.6%). LN metastases' number (>5) was a significant risk factor for persistent/recurrent disease only for N1a patients. CONCLUSIONS These data indicate that persistent/recurrent disease and distant metastases are significantly more frequent in patients with latero-cervical LN (N1b) metastases and that the LN location should be used for a better postsurgical risk stratification.
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Affiliation(s)
- G Sapuppo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - F Palermo
- Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Russo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Tavarelli
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - R Masucci
- Department of Surgical Oncology, Garibaldi-Nesima Medical Center, Catania, Italy
| | - S Squatrito
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - R Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
- Humanitas, Catania Oncology Center, Catania, Italy
- Institute of Biostructures and Bioimages, National Research Council, CNR, Catania, Italy
| | - G Pellegriti
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy.
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19
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Zheng CM, Ji YB, Song CM, Ge MH, Tae K. Number of Metastatic Lymph Nodes and Ratio of Metastatic Lymph Nodes to Total Number of Retrieved Lymph Nodes Are Risk Factors for Recurrence in Patients With Clinically Node Negative Papillary Thyroid Carcinoma. Clin Exp Otorhinolaryngol 2017; 11:58-64. [PMID: 29032663 PMCID: PMC5831665 DOI: 10.21053/ceo.2017.00472] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The number of metastatic lymph nodes (LNs) and the ratio between the number of metastatic LNs and the total number of retrieved LNs (the LN ratio [LNR]) have been proposed as risk factors for recurrence of papillary thyroid carcinoma (PTC). However, the significance of the number of LNs and the LNR in patients with clinically node negative PTC has not been clearly determined. The purpose of this study is to evaluate their significance. METHODS We retrospectively analyzed 382 patients with PTC who had undergone total thyroidectomy with prophylactic central neck dissection (CND) between January 2000 and December 2010. We excluded patients with lobectomy, concurrent lateral compartment neck dissection, a follow-up period less than at least 2 years, number of harvested central LNs less than or equal to one, clinically positive LN, distant metastasis, recurrent cancer or other types of malignancy. The correlations between recurrence and various clinicopathologic characteristics including tumor size, extrathyroidal extension (ETE), stage, number of metastatic central LNs, and the LNR were investigated. RESULTS After a mean follow-up period of 82.2±26.4 months, recurrence occurred in 14 patients (3.7%). Tumor size ≥20 mm, maximal ETE, presence of central LN metastasis, number of metastatic LNs ≥2, and LNR ≥0.31 correlated with recurrence in the univariate analysis. However, tumor size ≥20 mm, maximal ETE, number of metastatic LNs ≥2, and LNR ≥0.31 were significantly associated with recurrence in the multivariate analysis (hazard ratio=6.61, 7.17, 3.43, and 11.23, respectively). CONCLUSION The LNR and the number of metastatic LNs are independent prognostic risk factors for recurrence in patients with clinically node negative PTC, and these factors can be used to guide postoperative adjuvant therapy and follow-up strategy after prophylactic CND.
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Affiliation(s)
- Chuan-Ming Zheng
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ming-Hua Ge
- Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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20
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Jiang T, Huang C, Xu Y, Su Y, Zhang G, Xie L, Huang L, You S, Zha J. Ratio of positive lymph nodes: The prognostic value in stage IV thyroid cancer. Oncotarget 2017; 8:79462-79468. [PMID: 29108325 PMCID: PMC5668058 DOI: 10.18632/oncotarget.18402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/23/2017] [Indexed: 02/07/2023] Open
Abstract
To assess the prognostic value of lymph node ratio (LNR) in patients with stage IV thyroid cancer based on the Surveillance, Epidemiology, and End Results (SEER) database. A total of 4,940 eligible patients were included for the analysis. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to reveal the effect of LNR on overall survival (OS) and disease specific survival (DSS). The optimal cut-off value of LNR for predicting OS and DSS was determined by the time-dependent Receiver Operating Characteristic analysis. By the univariate Cox proportional hazard regression, LNR was significantly associated with OS and DSS in patients with medullary thyroid cancer (MTC), papillary thyroid cancer and anaplastic thyroid cancer (all P < 0.05). With the optimal cut-off value, Kaplan-Meier analysis showed that MTC patients with LNR≥76.5% were significantly associated with poorer OS (log-rank test: P < 0.0001), and LNR≥40.7% were significantly associated with poorer DSS (log-rank test: P < 0.0001). LNR was an independent prognostic factor of poorer survival in MTC patients after adjusting for other variables by multivariable Cox analysis (OS: hazard ratio [HR] = 2.560, 95% confidence interval [CI] 1.690-3.879, P < 0.0001; DSS: HR=2.781, 95% CI 1.582-4.888, P = 0.0004). Our results demonstrated that LNR could predict clinical outcomes in patients with stage IV MTC, and 76.5% was the optimal cut-off value of LNR to predict OS. LNR, as a function of the nodes positive and the nodes examined, could provide suggestions on the postoperative prognosis of patients with stage IV MTC.
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Affiliation(s)
- Tingyin Jiang
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Chunling Huang
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Yuan Xu
- Cancer Institute, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, China
| | - Yingrui Su
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Guanjie Zhang
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Long Xie
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Liqun Huang
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Shuchun You
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
| | - Jinshun Zha
- Department of Nuclear Medicine, Second Affiliated Hospital, Fujian Medicine University, Licheng, Quanzhou 362000, China
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Kim HI, Kim TH, Choe JH, Kim JH, Kim JS, Oh YL, Hahn SY, Shin JH, Jang HW, Kim YN, Kim H, Ahn HS, Kim K, Kim SW, Chung JH. Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size. Cancer Med 2017; 6:2244-2251. [PMID: 28857489 PMCID: PMC5633551 DOI: 10.1002/cam4.1160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/22/2017] [Accepted: 07/16/2017] [Indexed: 12/18/2022] Open
Abstract
The current 7th TNM staging stratifies N1b papillary thyroid cancer (PTC) patients without distant metastasis into either stage I or stage IV merely by an age threshold (45 years). To date, no studies have adequately quantified the mortality risk of PTC patients with N1b disease. We hypothesized that incorporating lymph node (LN) factors into the staging system would better predict cancer-specific mortality (CSM). A total of 745 nonmetastatic PTC patients with N1b disease were enrolled. We identified factors related to LNs and cut-points using Cox regression and time-dependent ROC analysis. New prognostic groupings were derived based on minimal hazard differences for CSM among the groups stratified by LN risk and age, and prediction of CSM was assessed. Lateral lymph node ratio (LNR) and largest LN size were significant prognostic LN factors at cut-points of 0.3 and 3 cm. Without LN risk (lateral LNR >0.3 or largest LN size >3 cm), stage IV patients had prognosis [adjusted HR 1.10 (98% CI 0.19-6.20); P = 0.906] similar to stage I patients with LN risk. Patients were restratified into three prognostic groups: Group 1, <45 years without LN risk; Group 2, <45 years with LN risk or ≥45 years without LN risk; and Group 3, ≥45 with LN risk. This system had a lower log-rank P-value (<0.001 vs. 0.002) and higher C-statistics (0.80 vs. 0.71) than the 7th TNM. New prognostic grouping using lateral LNR and largest LN size predicts CSM accurately and distinguishes N1b patients with different prognosis.
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Affiliation(s)
- Hye In Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Nam Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hosu Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Seon Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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22
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Roh JL, Park JW, Jeong J, Gong G, Cho KJ, Choi SH, Nam SY, Kim SY. Extranodal extension of lymph node metastasis as a prognostic indicator of recurrence and survival in papillary thyroid carcinoma. J Surg Oncol 2017; 116:450-458. [PMID: 28608492 DOI: 10.1002/jso.24713] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/28/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Stratification of extranodal extension (ENE) extent has the potential to improve the accuracy of risk estimations in papillary thyroid carcinoma (PTC). This study examined the prognostic importance of nodal factors, including ENE, in PTC patients. METHODS This study enrolled 2071 consecutive patients with treatment-naïve PTC who underwent thyroidectomy between 2006 and 2010. Microscopic/macroscopic ENE was determined by pathological and operative findings. Univariate and multivariate analyses were used to identify the relationship of factors with recurrence and survival in all study patients and in the node-positive subset. RESULTS Of 2071 patients, 975 (47.1%) had positive lymph nodes, and 271 (13.1%) and 70 (3.4%) had microscopic and macroscopic ENE, respectively. During a median follow-up of 96 months, 114 (5.5%) patients had post-treatment recurrence. Multivariate analyses showed that, in all patients, the number of positive nodes, lymph node ratio, ENE status, and ATA risk group were independent variables affecting recurrence (P < 0.05). T4 and macroscopic ENE were independent variables associated with shorter overall survival (P < 0.05). Macroscopic ENE was significantly associated with macroscopic extrathyroidal extension. CONCLUSION Macroscopic ENE has a significant adverse impact on recurrence and survival after treatment for PTC. ENE is considered a high risk factor for recurrence.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Woo Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Junhyeop Jeong
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyungyup Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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23
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Chang YW, Kim HS, Jung SP, Kim HY, Lee JB, Bae JW, Son GS. Significance of micrometastases in the calculation of the lymph node ratio for papillary thyroid cancer. Ann Surg Treat Res 2017; 92:117-122. [PMID: 28289664 PMCID: PMC5344800 DOI: 10.4174/astr.2017.92.3.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 12/24/2022] Open
Abstract
Purpose The lymph node ratio (LNR) is an important prognostic factor in papillary thyroid carcinoma (PTC), but micrometastases in cervical lymph nodes (LNs) are not of great clinical importance. In this study, we analyzed the accuracy of prediction of the prognosis depending on whether micrometastases were included in the number of metastatic LNs when calculating LNR. Methods The study included 353 PTC patients who underwent total thyroidectomy with neck LN dissection, and calculated LNR by 2 methods according to whether micrometastases were included in the number of metastatic LNs: Method 1 did not and method 2 did include. To compare the predictive values of LNR by the 2 methods, correlation coefficients and receiver operating characteristic (ROC) curves were analyzed. Results Positive correlations were found between LNR and preablation stimulated thyroglobulin (sTg) levels in both methods, but the correlation between method 1 LNR and preablation sTg level was significantly stronger than that for method 2 (Fisher z = 1.7, P = 0.045). The areas under these 2 independent ROC curves were analyzed; the prognostic efficacy of method 1 LNR was more accurate than that of method 2 LNR, and the difference was statistically significant (P = 0.0001). Conclusion Regional recurrence of PTC can be predicted more accurately by not including micrometastases in the number of metastatic LNs when calculating LNR.
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Affiliation(s)
- Young Woo Chang
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hwan Soo Kim
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung Pil Jung
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hoon Yub Kim
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae Bok Lee
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jeoung Won Bae
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
| | - Gil Soo Son
- Department of Breast Endocrine Surgery, Korea University College of Medicine, Seoul, Korea
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