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BMC Surg. 2019 Jul 5;19(1):78. doi: 10.1186/s12893-019-0541-5.

Identifying risk factors of recurrence for clinically node negative papillary thyroid carcinoma with pathologic N1a.

Author information

1
Department of Surgery, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
2
Department of Surgery, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea. sabiston@hotmail.com.

Abstract

BACKGROUND:

Whether or not to perform prophylactic central lymph node dissection (CLND) in the case of clinically node-negative papillary thyroid cancer (PTC) is controversial. The purpose of this study was to investigate the risk factors for recurrence in clinically node-negative PTC patients who underwent total thyroidectomy plus bilateral central neck dissection and was verified pathologic N1a.

METHODS:

We retrospectively reviewed the medical records of 1082 PTC patients who underwent total thyroidectomy and prophylactic bilateral CLND between January 2004 and December 2012. We used Cox-proportional hazard regression analyses in order to explore potential predictive factors for recurrence.

RESULTS:

During a median follow-up (range) of 78 (12-158) months, recurrence occurred in 62 (5.7%) patients. Main tumor size more than 1 cm, gross extrathyroidal extension (ETE), positive lymph node (LN) more than 3, and LN ratio > 0.5 were all significantly associated with recurrence according to univariate analysis. In model I multivariate analysis (tumor size, gross ETE, LN ratio), LN ratio > 5 (hazards ratio [HR], 4.794; 95% confidence interval [CI], 2.674-8.595; p < 0.001) was found to be predictive of recurrence. Gross ETE (HR, 1.794; 95% CI, 1.024-3.143; p = 0.041) and positive LN more than 3 (HR, 2.505; 95% CI, 1.513-4.146; p < 0.001) were predictors for recurrence in model II multivariate analysis (tumor size, gross ETE, the number of positive LN).

CONCLUSIONS:

We recommend that surgeons try to focus completely on performing prophylactic CLND for patients with suspicious gross ETE during preoperative evaluation. Close monitoring and thorough management are needed for clinically node-negative PTC patients with LN ratio of more than 0.5 and more than 3 positive LN in the central compartment.

KEYWORDS:

Papillary thyroid cancer; Prophylactic central neck dissection; Recurrence

PMID:
31277631
PMCID:
PMC6612157
DOI:
10.1186/s12893-019-0541-5
[Indexed for MEDLINE]
Free PMC Article

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