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Prognostic implications of lymph node yield and lymph node ratio in papillary thyroid carcinoma
Jonathan H Vas Nunes1, Jonathan R Clark, Kan Gao
1University of Groningen, Groningen, The Netherlands. jhvasnunes@gmail.com
Thyroid : Official Journal of the American Thyroid Association
|February 5, 2013
Summary
The lymph node ratio (LNR) is a key prognostic factor for papillary thyroid cancer (PTC) recurrence. A higher LNR indicates a greater risk, while a lower LNR is associated with better disease-free survival.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Prognostics
Background:
- Lymph node yield (LNY) and lymph node ratio (LNR) are established prognostic factors in various cancers.
- Their prognostic significance in papillary thyroid cancer (PTC) remains unclear.
- This study investigates the impact of LNY and LNR on disease-free survival in PTC.
Purpose of the Study:
- To determine if a high LNR and low LNY decrease disease-free survival in PTC patients.
- To identify an optimal lymph node yield for prognostic assessment in PTC.
Main Methods:
- Retrospective analysis of 198 PTC patients undergoing total thyroidectomy and neck dissection (1987-2011).
- Multivariate Cox regression with Andersen-Gill extension to analyze LNY and LNR adjusted for covariates.
Main Results:
- LNR significantly decreased disease-free survival (HR 3.2, p=0.005).
- LNR ≥ 0.30 increased persistent/recurrent disease risk (HR 3.4, p=0.031).
- LNR ≤ 0.11 correlated with an 80% 5-year disease-free survival rate; LNY had no independent effect.
Conclusions:
- LNR is an independent prognostic factor in PTC, valuable for staging systems.
- A clinical cutoff of LNR 0.3 (1 positive node in 3) is proposed.
- LNY did not show prognostic implications in this PTC cohort.
