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

Stéphane Bardet1, Elodie Malville, Jean-Pierre Rame

  • 1Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, 3 Avenue Général Harris, BP 5026, F-14076 Caen Cedex 05, France. s.bardet@baclesse.fr

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Lymph-node dissection (LND) significantly impacts lymph-node recurrence (LNR) risk in papillary thyroid cancer patients with macroscopic lymph-node involvement. Optimal LND at primary surgery is crucial for reducing LNR risk in these patients.

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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.