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Erschienen in: Annals of Surgical Oncology 8/2018

29.05.2018 | Head and Neck Oncology

Central Lymph Node Status has Significant Prognostic Value in the Clinically Node-Negative Tall-Cell Variant of Papillary Thyroid Cancer Regardless of T-Staging and Radioactive Iodine Administration: First Evidence From a Population-Based Study

verfasst von: Xiao Shi, MD, Nai-Si Huang, MD, Bo-Wen Lei, BM, Ke-Han Song, MD, Rong-Liang Shi, PhD, Wen-Jun Wei, MD, Wei-Ping Hu, BM, Fan Dong, MD, Yu Wang, MD, Yu-Long Wang, MD, PhD, Qing-Hai Ji, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2018

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Abstract

Background

The prognostic value of central lymph node (CLN) status in papillary thyroid cancer (PTC) remains controversial. This study aimed to provide the first evidence on this issue for the aggressive tall-cell variant (TCV) subtype.

Methods

The study identified TCV patients from the Surveillance, Epidemiology, and End Results database. The Kaplan–Meier method, log-rank test, and multivariate Cox regression models were used for analysis.

Results

Of the 744 patients included, 404 were recorded as N0, which were pathologically or only clinically confirmed. Overall survival (OS) and cancer-specific survival (CSS) did not differ significantly between the N0 and pN1a patients (p > 0.05). To investigate the reason, the N0 patients were subdivided according to the number of examined lymph nodes (ELN). The patients with a N0 diagnosis confirmed by two or more ELNs (N0-e2+) showed significantly better outcomes than the pN1a patients and their N0 counterparts without ELN (N0-e0) (p < 0.05), whereas the N0-e0 and pN1a groups demonstrated comparable outcomes in both the log-rank and multivariate analyses (p > 0.05). Moreover, the subgroup analyses showed that even among the patients with early T-staging (T1–T2) or receipt of radioactive iodine (RAI) therapy, the N0-e0 patients still demonstrated compromised OS compared with the N0-e2+ group (p < 0.05).

Conclusion

The cN0 patients without ELN (N0-e0) had outcomes similar to those of the pN1a patients, but showed a poorer OS than the N0-e2+ group regardless of T-staging and RAI administration, suggesting that occult CLN metastases might act as a negative prognosticator in cN0 TCV. Therefore, prophylactic central neck dissection might be considered for biopsy-proven cN0 TCV patients. Prospective studies are expected to further validate our conclusions.
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Metadaten
Titel
Central Lymph Node Status has Significant Prognostic Value in the Clinically Node-Negative Tall-Cell Variant of Papillary Thyroid Cancer Regardless of T-Staging and Radioactive Iodine Administration: First Evidence From a Population-Based Study
verfasst von
Xiao Shi, MD
Nai-Si Huang, MD
Bo-Wen Lei, BM
Ke-Han Song, MD
Rong-Liang Shi, PhD
Wen-Jun Wei, MD
Wei-Ping Hu, BM
Fan Dong, MD
Yu Wang, MD
Yu-Long Wang, MD, PhD
Qing-Hai Ji, MD
Publikationsdatum
29.05.2018
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2018
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6542-2

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