Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma

Area of Science:

• Oncology
• Surgical Oncology
• Endocrinology

Background:

• Papillary thyroid cancer (PTC) recurrence risk is influenced by lymph node status.
• The role of lymph-node dissection (LND) and the prognostic significance of lymph node involvement in PTC remain debated.
• Identifying factors predicting lymph-node recurrence (LNR) is critical for optimal patient management.

Purpose of the Study:

• To evaluate the influence of different LND procedures on LNR risk in PTC patients.
• To identify independent risk factors for LNR in PTC.
• To determine the prognostic impact of macroscopic versus microscopic lymph-node involvement.

Main Methods:

• Retrospective analysis of 545 PTC patients with primary tumors ≥10 mm and no distant metastases.
• Patients were categorized into three groups based on LND extent: no LND, bilateral central and lateral LND, or other LND modalities.
• 10-year cumulative LNR probability was assessed using multivariate analysis.

Main Results:

• Macroscopic lymph-node metastases, extra-thyroidal invasion, and male gender were independent LNR risk factors.
• Bilateral LND of central and lateral compartments demonstrated a protective effect against LNR (P=0.028).
• In patients with macroscopic lymph-node metastases, bilateral LND resulted in a significantly lower 10-year LNR probability compared to other LND groups (10% vs 30%, P<0.01).

Conclusions:

• Macroscopic lymph-node involvement, not microscopic, is a major determinant of LNR risk in PTC.
• Optimal lymph-node dissection during primary surgery is essential for patients with macroscopic lymph-node metastases.
• Prophylactic bilateral central and lateral LND may reduce LNR risk in selected PTC patients.