Elsevier

Surgery

Volume 159, Issue 1, January 2016, Pages 31-40
Surgery

Thyroid Clinical
Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study

Presented at the Annual Meeting of the American Association of Endocrine Surgeons on May 17–19, 2015, Nashville, TN.
https://doi.org/10.1016/j.surg.2015.08.032Get rights and content

Background

There is no consensus regarding prophylactic central lymph node dissection (pCLND) in patients with papillary thyroid carcinoma (PTC). Identification of risk factors for central lymph node metastasis (CLNM) in patients with PTC could assist surgeons in determining whether to perform selective pCLND.

Methods

The National Cancer database was queried from 1998 to 2011 for patients with clinical staging T1-4cN0M0 PTC. All patients underwent near, sub-, or total thyroidectomy with or without pCLND. Univariate and multivariable logistic regressions were performed on the following clinical variables: age, sex, race and tumor size as risk factors for pathologic CLNM (pN1a).

Results

In 39,562 patients with T1-4cN0M0 PTC, 61% underwent pCLND. Patients with age >45 years, African American race, tumor size ≤1 cm, unifocal tumors, follicular variant PTC, no insurance, and treatment at community cancer facilities were less likely to have pCLND (P < .001). In the pCLND group, 15.6% of patients had CLNM. On adjusted multivariable logistic regression, age ≤45 years, Asian race, male sex, and larger tumors were statistically significantly associated with CLNM.

Conclusion

Age ≤45 years, Asian race, male sex, and larger tumors are associated with the presence of CLNM, which allows for selective pCLND in PTC.

Section snippets

Methods

The NCDB is a database maintained by the American College of Surgeons Commission on Cancer with inclusion of information from approximately 1,500 hospitals with Commission on Cancer–accredited cancer programs. The NCDB captures approximately 80% of all newly diagnosed cancers in United States. Deidentified and Health Insurance Portability and Accountability Act–compliant data are provided to participating institutions on request for research purposes. The NCDB was queried for a period from 1998

Clinical characteristics and operative parameters

There were 39,562 patients in the NCDB from 1998 to 2011 with no distant metastasis (M0) who had near, sub-, or total thyroidectomy and met the inclusion criteria. All were clinically node negative (cN0). Patient demographics and clinicopathologic variables are described in Table I. A majority of the patients (80%) were women. Mean age at diagnosis was 48.8 ± 14.3 years (±SD) with 57.4% of patients older than 45 years of age. White patients constituted the largest racial group at 86.8%, whereas

Discussion

The National Clinical Cancer Network7 and American Thyroid Association8 provide no clear guidelines for or against the performance of pCLND for patients with PTC. Consequently, the role of pCLND remains a subject of debate. The presence of occult or clinically evident LN metastasis in the central compartment is thought to be associated with increased recurrence of PTC.4, 5, 6 In a study of 201 patients with cN0 differentiated thyroid carcinoma reported by Patron et al5 from France, the presence

References (23)

  • D.M. Hartl et al.

    Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma

    Ann Surg

    (2012)
  • Cited by (43)

    • SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Surgical treatment

      2022, Annales d'Endocrinologie
      Citation Excerpt :

      The prevalence of occult lymph-node metastasis in the central compartment is high. Several risk factors have been identified in this compartment: young age (< 45 years), male gender, tumor size, and infiltration of perithyroid fat tissue [18]. Currently, there is no evidence that prophylactic central neck dissection improves overall survival, which is similar in N0 and Nx patients [19].

    • Physiology and Diseases of the Thyroid Gland in the Elderly: Thyroid Cancer

      2020, Endocrinology of Aging: Clinical Aspects in Diagrams and Images
    • Reconsideration of tumor size threshold for total thyroidectomy in differentiated thyroid cancer

      2018, Surgery (United States)
      Citation Excerpt :

      It should be emphasized that all patients in this study were of Asian ethnicity in a BRAF V600E mutation-prevalent country. An analysis of NCDB patients with papillary thyroid cancer revealed that Asian race is one of the factors associated with central lymph node metastasis.43 Furthermore, Asian women generally are at a younger age at diagnosis than Caucasian women.44

    • High suspicion US pattern on the ATA guidelines, not cytologic diagnosis, may be a predicting marker of lymph node metastasis in patients with classical papillary thyroid carcinoma

      2018, American Journal of Surgery
      Citation Excerpt :

      On the other hand, one prospective study showed an opposite result.18 In our study, cytologic features based on the Bethesda system were not associated with LNM, although LNM has consistently shown association with tumor size, younger age, and male gender, in previous studies.31,32 There are some limitations in our study.

    View all citing articles on Scopus
    View full text