J Korean Med Sci.  2014 Jan;29(1):48-52. 10.3346/jkms.2014.29.1.48.

Central Lymph Node Metastasis Is an Important Prognostic Factor in Patients with Papillary Thyroid Microcarcinoma

• Lee J
• Song Y
• Soh EY

• KMID: 1796914
• DOI: http://doi.org/10.3346/jkms.2014.29.1.48

Abstract

Papillary thyroid microcarcinoma (PTMC) has been increasing, without a consensus for the management of this condition. In the present study, we analyzed the clinicopathological features of patients with PTMC to examine the impact of initial therapy and establish appropriate treatment. A total of 2,018 patients with PTMC were enrolled at a single university hospital. Of them, 1,245 patients (61.8%) underwent total thyroidectomy, and 1,838 patients (91.3%) underwent central lymph node (LN) dissection. Five-and 10-yr recurrence rates were 3.2% and 4.6%, respectively. In univariate analysis, the prognostic factors for recurrence were N stage, the number of LN metastases, and extrathyroidal extension. However, multivariate analysis revealed LN metastases and N stage as the only significant prognostic factors after adjusting for confounding factors (P < 0.001). Additionally, multivariate analysis of a subgroup consisting of PTMC patients without N1b revealed the number of central LN metastases as the only significant factor. Therefore, intraoperative examination for central LN metastasis may discriminate high or low risk group.

Keyword

Papillary Thyroid Carcinoma; Lymph Node Metastasis; Recurrence

MeSH Terms

Carcinoma, Papillary/*pathology/radiotherapy/surgery
Female
Humans
Iodine Radioisotopes/therapeutic use
Lymph Node Excision
Lymph Nodes/*pathology/surgery
Lymphatic Metastasis/*pathology
Male
Middle Aged
Neoplasm Recurrence, Local/surgery
Prognosis
Retrospective Studies
Risk Factors
Thyroid Neoplasms/*pathology/radiotherapy/surgery
Thyroidectomy
Iodine Radioisotopes

Figure

• 

  Fig. 1 Recurrence-free rate in patients with papillary thyroid microcarcinoma. (A) Related to N stage, (B) number of LN metastases.

Reference

1. Vasileiadis I, Karakostas E, Charitoudis G, Stavrianaki A, Kapetanakis S, Kouraklis G, Karatzas T. Papillary thyroid microcarcinoma: clinicopathological characteristics and implications for treatment in 276 patients. Eur J Clin Invest. 2012; 42:657–664.

2. Lee NS, Bae JS, Jeong SR, Jung CK, Lim DJ, Park WC, Kim JS, Kim SN. Risk factors of lymph node metastasis in papillary thyroid microcarcinoma. J Korean Surg Soc. 2010; 78:82–86.

3. Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, Pearce EN, Braverman LE, Degli Uberti EC. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006; 91:2171–2178.

4. Cho BY. Clinical thyroidology. 3rd ed. Seoul: Korea Medical Book;2010.

5. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–1214.

6. Tuttle RM, Ball DW, Byrd D, Dilawari RA, Doherty GM, Duh QY, Ehya H, Farrar WB, Haddad RI, Kandeel FK, et al. NCCN clinical practice guidelines in oncology: thyroid carcinoma. accessed on 28 November 2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.

7. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998; 124:958–964.

8. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006; 154:787–803.

9. Zhao Q, Ming J, Liu C, Shi L, Xu X, Nie X, Huang T. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol. 2013; 20:746–752.

10. Rodriguez JM, Moreno A, Parrilla P, Sola J, Soria T, Tebar FJ, Aranda F. Papillary thyroid microcarcinoma: clinical study and prognosis. Eur J Surg. 1997; 163:255–259.

11. Kim WJ, Bae MJ, Yi YS, Jeon YK, Kim SS, Kim BH, Kim IJ. Clinicopathologic characteristics of papillary microcarcinoma in the elderly. J Korean Thyroid Assoc. 2013; 6:69–74.

12. Wada N, Duh QY, Sugino K, Iwasaki H, Kameyama K, Mimura T, Ito K, Takami H, Takanashi Y. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003; 237:399–407.

13. Hay ID. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am. 1990; 19:545–576.

14. DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990; 71:414–424.

15. Buffet C, Golmard JL, Hoang C, Trésallet C, Du Pasquier Fédiaevsky L, Fierrard H, Aurengo A, Menegaux F, Leenhardt L. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur J Endocrinol. 2012; 167:267–275.

16. Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope. 2004; 114:393–402.

17. Koo BS, Lim HS, Lim YC, Yoon YH, Kim YM, Park YH, Rha KS. Occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma. Ann Surg Oncol. 2010; 17:1101–1105.

18. Bonnet S, Hartl D, Leboulleux S, Baudin E, Lumbroso JD, Al Ghuzlan A, Chami L, Schlumberger M, Travagli JP. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment. J Clin Endocrinol Metab. 2009; 94:1162–1167.

19. Rose RG, Kelsey MP, Russell WO, Ibanez ML, White EC, Clark RL. Follow-up study of thyroid cancer treated by unilateral lobectomy. Am J Surg. 1963; 106:494–500.

20. Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg. 1992; 16:711–716.

21. Borson-Chazot F, Causeret S, Lifante JC, Augros M, Berger N, Peix JL. Predictive factors for recurrence from a series of 74 children and adolescents with differentiated thyroid cancer. World J Surg. 2004; 28:1088–1092.

22. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, Mclver B, Sherman SI, Tuttle RM. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006; 16:109–142.

23. Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim EK. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009; 193:871–878.

24. Shimamoto K, Satake H, Sawaki A, Ishigaki T, Funahashi H, Imai T. Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol. 1998; 29:4–10.

25. Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006; 140:1000–1005.

26. Kim MK, Mandel SH, Baloch Z, Livolsi VA, Langer JE, Didonato L, Fish S, Weber RS. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg. 2004; 130:1214–1216.

27. Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998; 22:718–724.

28. Goretzki PE, Simon D, Frilling A, Witte J, Reiners C, Grussendorf M, Horster FA, Röher HD. Surgical reintervention for differentiated thyroid cancer. Br J Surg. 1993; 80:1009–1012.

29. Caliskan M, Park JH, Jeong JS, Lee CR, Park SK, Kang SW, Jeong JJ, Chung WY, Park CS. Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma. Endocr J. 2012; 59:305–311.