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An evaluation of lymph node yield and lymph node ratio in well-differentiated thyroid carcinoma
Shannon H Beal1, Steven L Chen, Philip D Schneider
1University of California at Davis, Department of Surgery, Division of Surgical Oncology, UC Davis Cancer Center, Sacramento, California 95817, USA.
The American Surgeon
|February 9, 2010
Summary
The number of lymph nodes harvested (LNY) and metastatic lymph node ratio (MLNR) impact survival in well-differentiated thyroid carcinoma (WDTC). Increased LNY correlates with poorer survival, even in node-negative patients, suggesting nodal understaging is not a factor.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Survival outcomes for well-differentiated thyroid carcinoma (WDTC) are influenced by various factors.
- The impact of lymph node yield (LNY) and metastatic lymph node ratio (MLNR) on WDTC survival remains unclear.
Purpose of the Study:
- To investigate the influence of lymph node yield (LNY) and metastatic lymph node ratio (MLNR) on overall survival in patients with well-differentiated thyroid carcinoma (WDTC).
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify 9926 patients with primary, nonmetastatic WDTC undergoing thyroidectomy with lymph node removal (1988-2004).
- Employed Kaplan-Meier survival analysis and log rank tests for univariate comparisons.
- Conducted multivariate Cox proportional hazards modeling incorporating tumor and patient-specific factors.
Main Results:
- Univariate analysis revealed significant impacts of LNY and MLNR on survival (P < 0.001).
- Multivariate analysis showed increasing LNY was associated with poorer survival in all patients (P = 0.001) and node-negative patients (P = 0.03), but not node-positive patients (P = 0.27).
- MLNR did not significantly influence survival in node-positive patients (P = 0.84).
Conclusions:
- In WDTC patients treated with thyroidectomy and lymphadenectomy, higher LNY and MLNR are linked to decreased survival.
- The association of increased LNY with reduced survival, even in node-negative cases, suggests that nodal understaging is not a significant determinant of WDTC survival.