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Distant lymph node metastasis in differentiated thyroid cancer: A population-based cohort study.

Ying Ding1, Ruixin Zhou2

  • 1Department of Breast Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China; Postdoctoral Station of Medical Aspects of Specific Environments, the Third Xiangya Hospital, Central South University, Changsha, China; Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
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Summary

Distant lymph node metastasis (LNM) in differentiated thyroid cancer (DTC) is rare but serious, negatively impacting survival. Radioactive iodine therapy showed no survival benefit for DTC patients with distant LNM.

Keywords:
DTCDistant LNMPrognosisRAIRisk factors

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Area of Science:

  • Oncology
  • Endocrinology
  • Cancer Research

Background:

  • Cervical lymph node metastasis (LNM) is common in differentiated thyroid cancer (DTC).
  • The incidence, pattern, treatment, and prognosis of distant LNM in DTC remain underreported.
  • Understanding distant LNM is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the incidence, risk factors, and prognostic impact of distant LNM in DTC patients.
  • To develop a predictive nomogram for distant LNM in DTC.
  • To evaluate the efficacy of radioactive iodine (RAI) therapy in DTC patients with distant LNM.

Main Methods:

  • Analysis of DTC patients with distant LNM from the 2016-2020 SEER database.
  • Utilized multivariate models and propensity score matching (PSM) for covariate adjustment.
  • Kaplan-Meier method for survival analysis; nomogram development and validation using calibration and ROC curves.

Main Results:

  • 100 (0.24%) of 42,339 DTC patients had distant LNM.
  • Identified risk factors for distant LNM include older age, male sex, advanced T/N stage, and distant metastases (bone, brain, lung).
  • Distant LNM significantly worsened prognosis; RAI therapy did not improve overall or cancer-specific survival.

Conclusions:

  • Distant LNM is a rare but grave complication of DTC, significantly reducing survival.
  • Key predictors of distant LNM include older age, male sex, advanced disease stage, and other metastases.
  • Current RAI therapy offers no significant survival advantage for DTC patients with distant LNM.