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Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma.

ABSTRACT: Background:Unilateral multifocal papillary thyroid microcarcinoma (UM-PTMC) is not rare, and the suitable extent of operation is controversial. Total thyroidectomy is associated with a high risk of hypoparathyroidism and recurrent laryngeal nerve injury. Hemithyroidectomy should be considered in patients without lymph node metastases. This study aimed to identify factors predicting central lymph node metastases (CLNM) in patients with UM-PTMC. Methods:A total of 1,453 patients with thyroid cancer underwent surgery at our hospital from January 2018 to June 2018, and 115 patients with UM-PTMC were selected and assessed retrospectively. The relationship between CLNM and clinicopathologic features of UM-PTMC were analyzed by both univariate and multivariate analyses. Results:Of the 115 patients with UM-PTMC, CLNM were confirmed by pathology in 57 patients. Univariate and multivariate analyses identified the sum diameter of all tumors (?1.0 cm) [odds ratio (OR) =2.295; 95% confidence interval (CI): 1.036-5.086; P=0.041] and positive CLNM via ultrasonography (OR =5.882; 95% CI: 1.562-22.153; P=0.009) as independent predictors of CLNM. Conclusions:CLNM are common in patients with UM-PTMC. The sum diameter of all tumors (?1.0 cm) and positive CLNM via ultrasonography are independent risk factors for CLNM. Our data should be considered in the decision process relating to performing total thyroidectomy or hemithyroidectomy in patients with UM-PTMC.

SUBMITTER: Wu X

PROVIDER: S-EPMC7347816 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma.

Wu Xin X Li Binglu B Zheng Chaoji C He Xiaodong X

Gland surgery 20200601 3

<h4>Background</h4>Unilateral multifocal papillary thyroid microcarcinoma (UM-PTMC) is not rare, and the suitable extent of operation is controversial. Total thyroidectomy is associated with a high risk of hypoparathyroidism and recurrent laryngeal nerve injury. Hemithyroidectomy should be considered in patients without lymph node metastases. This study aimed to identify factors predicting central lymph node metastases (CLNM) in patients with UM-PTMC.<h4>Methods</h4>A total of 1,453 patients wit ...[more]

PMID: 32775259

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Project description:The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

Dataset Information

Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma.

Publications

Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma.

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