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Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3609–3616 | Cite as

Risk Factors for Lateral Neck Recurrence of N0/N1a Papillary Thyroid Cancer

  • Yehree Kim
  • Jong-Lyel Roh
  • Gyungyup Gong
  • Kyung-Ja Cho
  • Seung-Ho Choi
  • Soon Yuhl Nam
  • Sang Yoon Kim
Endocrine Tumors

Abstract

Background

Current guidelines advocate no prophylactic dissection of the lateral neck compartment for papillary thyroid carcinoma (PTC) without clinical evidence of lateral neck metastasis (cN1b). However, lateral neck recurrence can affect patient treatment outcomes and quality of life. Therefore, this study examined the risk factors for lateral neck recurrence after the definitive treatment of PTC without cN1b.

Methods

The study enrolled 1928 consecutive patients who underwent total thyroidectomy between 2006 and 2012 for PTC without cN1b. Logistic regression analysis was used to identify the relationship of clinicopathologic factors with lateral neck recurrence. Uni- and multivariate Cox-proportional hazards regression analyses were used to identify factors predictive of lateral neck recurrence-free survival (LRFS).

Results

During a median follow-up period of 94 months (range, 24–133 months), lateral neck recurrence occurred in 47 patients (2.4%). Binary logistic regression showed that tumor size (>2 cm), multifocality, clinical central neck metastasis (cN1a), number of positive lymph nodes (LNs, >5), and LN ratio (>0.5) were significantly associated with lateral neck recurrence (P < 0.05). Multivariate analyses showed that multifocality (hazards ratio [HR], 2.338; 95% confidence interval [CI], 1.126–4.858; P = 0.023), cN1a (HR, 5.301; 95% CI, 2.416–11.630; P < 0.001), LN ratio (HR, 2.628; 95% CI, 1.228–5.626; P = 0.013), extranodal extension (HR, 2.570; 95% CI, 1.063–6.213; P = 0.036), and MACIS (distant metastasis, patient age, completeness of resection, local invasion and tumour size) score (HR, 2.513; 95% CI, 1.211–5.216; P = 0.013) were independent factors for LRFS.

Conclusions

Lateral neck recurrence after thyroidectomy is predicted by the clinicopathologic factors of multifocality, cN1a, LN ratio, extranodal extension, and MACIS score in N0/N1a PTC patients.

Notes

Acknowledgments

This study was supported by a grant (No. 2015R1A2A1A15054540) from the Basic Science Research Program through the National Research Foundation of Korea (NRF), Ministry of Science, ICT, and Future Planning, and a grant (No. HI15C2920) from the Korean Health Technology R&D Project through the Korea Health Industry Development Institute, Ministry of Health & Welfare, Seoul, Republic of Korea (J.-L. Roh).

Disclosures

The authors have declared no conflict of interest.

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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Yehree Kim
    • 1
  • Jong-Lyel Roh
    • 1
  • Gyungyup Gong
    • 2
  • Kyung-Ja Cho
    • 2
  • Seung-Ho Choi
    • 1
  • Soon Yuhl Nam
    • 1
  • Sang Yoon Kim
    • 1
  1. 1.Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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