Risk Factors for Recurrence After Therapeutic Lateral Neck Dissection for Primary Papillary Thyroid Cancer
- 601 Downloads
Lateral lymph node metastasis is an important prognostic factor and is predictive of tumor recurrence and cause-specific survival in patients with papillary thyroid cancer (PTC). However, the factors predicting recurrence and clinical outcomes after therapeutic lateral neck dissection are not well established. The aims of this study were to evaluate the incidence, pattern, and factors predictive of PTC recurrence after therapeutic lateral neck dissection.
Materials and Methods
The records of 126 consecutive patients who underwent total thyroidectomy with therapeutic lateral neck dissection for primary PTC at the National Cancer Center were retrospectively reviewed. The factors predictive of recurrence were determined using both univariate and multivariate analyses considering several clinicopathologic variables.
The median follow-up period was 61.2 months, during which 22 patients (17.5 %) experienced recurrence with 1 death (0.8 %) due to disease. Locoregional recurrence and distant metastasis were found in 20 cases (15.9 %) and 2 cases (1.6 %), respectively. Male gender, aggressive histology, number of lymph node metastases, initial level of T4-off Tg per ng/mL, and ATA risk categories (high risk) were independent risk factors for recurrence. Of note, initial T4-off Tg levels greater than 4.2 ng/mL showed highest sensitivity and specificity in predicting recurrence.
These results provide useful information regarding the clinical outcomes after therapeutic lateral neck dissection for primary PTC and can be used to identify at-risk patients who need aggressive treatment and intensive surveillance for postoperative recurrence.
KeywordsPapillary Thyroid Cancer Locoregional Recurrence Extrathyroidal Extension BRAFV600E Mutation Lateral Lymph Node Metastasis
This work was supported by a research grant from the National Cancer Center (No. 0810100-1).
- 8.Edge SB, Byrd DR, Compton CC. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010.Google Scholar
- 11.Leboulleux S, Rubino C, Baudin, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005;90:5723–9.PubMedCrossRefGoogle Scholar
- 14.Lim I, Kim SK, Hwang SS, Kim SW, Chung KW, Kang HS, et al. Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer. Ann Nucl Med. 2012;26:777–86.PubMedCrossRefGoogle Scholar
- 16.Ricarte-Filho J, Ganly I, Rivera M, Katabi N, Fu W, Shaha A, et al. Papillary thyroid carcinoma with cervical lymph node metastases can be stratified into clinically relevant prognostic categories using oncogenic BRAF, the number of nodal metastases, and extra-nodal extension. Thyroid. 2012;22:575–84.PubMedCrossRefGoogle Scholar