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Published on: June 2, 2023
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Predictive factors for nodal recurrence in differentiated thyroid cancers.
Japneet Kaur1, Abinaya Nadarajan1, Deepak Janardhan1
1Department of Surgical Services, Regional Cancer Centre, Thiruvananthapuram, India.
Cancer Treatment and Research Communications
|June 19, 2023
Summary
Extrathyroidal extension and multifocality are key risk factors for differentiated thyroid cancer recurrence. BRAF and TERT mutations indicate aggressive disease and early recurrence, guiding treatment strategies.
Area of Science:
- Endocrinology
- Oncology
- Surgical Oncology
Background:
- Differentiated thyroid carcinoma (DTC) generally has a favorable prognosis, with surgery and radioactive iodine ablation as primary treatments.
- Local and distant recurrence rates can reach 30%, necessitating effective risk stratification and management strategies.
- Identifying specific risk factors for structural recurrence is crucial for optimizing patient care and follow-up protocols.
Purpose of the Study:
- To investigate the risk factors associated with structural recurrence in differentiated thyroid carcinoma.
- To analyze the patterns of recurrence in node-negative thyroid cancer patients following total thyroidectomy.
- To evaluate the predictive value of specific clinical and molecular factors for nodal metastasis.
Main Methods:
- Retrospective cohort study of 1498 patients with DTC, including 137 with cervical nodal recurrence post-thyroidectomy (Jan 2017-Dec 2020).
- Univariate and multivariate analyses were performed to identify risk factors for central and lateral lymph node metastasis.
- Factors analyzed included age, gender, T-stage, extrathyroidal extension (ETE), multifocality, high-risk variants, and TERT/BRAF mutations.
Main Results:
- Lateral compartment nodal recurrence (84%) was more frequent than isolated central compartment recurrence (16%).
- Multifocality, ETE, and age were significant predictors for lateral compartment recurrence on multivariate analysis.
- Multifocality, ETE, and high-risk variants significantly predicted central compartment nodal metastasis; TERT/BRAF mutations were linked to early recurrences.
Conclusions:
- Extrathyroidal extension and multifocality are significant risk factors for nodal recurrence in DTC.
- BRAF and TERT mutations are associated with an aggressive clinical course and earlier recurrences.
- The role of prophylactic central compartment lymph node dissection appears limited based on these findings.
