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Is there a relationship between patient age, tumor multifocality, and capsular invasion in papillary thyroid carcinoma? Retrospective evaluation of pathology specimens. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1061503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rui ZY, Liu Y, Zheng W, Wang X, Meng ZW, Tan J, Li N, Jia Q. A retrospective study of the risk factors and the prognosis in patients with papillary thyroid carcinoma depending on the number of lymph node metastasis. Clin Exp Med 2021; 21:277-286. [PMID: 33386568 DOI: 10.1007/s10238-020-00675-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
To retrospectively analyze the risk factors and the prognosis according to the number of lymph node metastases (LNMs) in different neck compartments in papillary thyroid carcinoma (PTC) patients. In total, 962 patients with PTC were enrolled in this study. According to the methods of the 2015 American Thyroid Association, the treatment response of the patients was divided into a good prognosis and a poor prognosis. First, their clinical characteristics were summarized. Then, according to whether they had LNMs and the number of LNMs in different neck compartments, their risk factors and their prognosis were analyzed. Male sex, younger (< 45 years), extrathyroid extension (ETE), T1 staging and higher stimulated thyroglobulin (sTg) levels were the risk factors for LNM. The cutoff for a poor prognosis of the number of LNMs was > 4. Male sex, younger age, higher sTg levels and ETE were correlated with LNM > 4. Furthermore, the cutoffs for a poor prognosis of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and CLNM + LLNM were > 6, > 1 and > 5, respectively. Younger age and ETE were strongly correlated with CLNM > 6. Male sex, younger age, higher sTg levels and ETE were correlated with LLNM > 1. Younger age, ETE and higher sTg levels were correlated with CLNM + LLNM > 5. Further analysis revealed a positive correlation between CLNM and LLNM. We should pay more attention to LNMs in PTC patients who are male, are of a younger age, have ETE, T1 staging and have higher sTg levels. The neck regional LNMs should be correctly evaluated to guide the surgical options for the neck LNMs in PTC. When the number of LNMs in different neck compartments has exceeded the cutoff value, they can be considered as predictors of the outcome of 131I treatment.
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Affiliation(s)
- Zhong Ying Rui
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China.
| | - Xuan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Zhao Wei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
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Wu X, Li BL, Zheng CJ, He XD. Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma. World J Clin Cases 2020; 8:1350-1360. [PMID: 32368529 PMCID: PMC7190943 DOI: 10.12998/wjcc.v8.i8.1350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/04/2020] [Accepted: 04/04/2020] [Indexed: 02/05/2023] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in its longest dimension. The incidence of PTMC is increasing worldwide. Surgery is the primary treatment; however, prophylactic central lymph node dissection is controversial, and discrepancies between different guidelines have been noted. Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis, while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients. To selectively perform prophylactic lymph node dissections in high-risk patients, it is important to identify predictive factors for lymph node metastases in patients with PTMC. Several studies have reported on this, but their conclusions are not entirely consistent. Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases, and the most commonly reported factors include age, gender, tumor size and location, multifocality, bilaterality, extrathyroidal extension, and abnormal lymph node found using ultrasound. Here, we provide an overview of previous studies along with a favorable opinion on or against these factors, with the aim of increasing the understanding of this topic among the medical community. In addition, current opinions about prophylactic central lymph node dissection are reviewed and discussed.
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Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing-Lu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chao-Ji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Dong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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