Risk stratification of lateral neck recurrence for patients with pN1a papillary thyroid cancer

• Published in: BMC cancer 2022-12, Vol.22 (1), p.1-1246, Article 1246
• Main Authors: Xu, Siyuan, Huang, Hui, Huang, Ying, Wang, Xiaolei, Xu, Zhengang, Liu, Shaoyan, Liu, Jie
• Format: Article
• Language: English
• Subjects: Cancer; Central lymph node metastasis; Dissection; Lateral neck recurrence; Lymph nodes; Lymphatic system; Medical prognosis; Metastases; Metastasis; Multivariate analysis; Neck; Papillary thyroid cancer; Papillary thyroid carcinoma; Patients; Primary tumor size; Prognosis; Relapse; Risk factors; Statistics; Thyroid cancer; Thyroidectomy; Tumors; Ultrasonic imaging
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-022-10326-8

Background Lateral neck is not recommended for dissection in patients with pN1a papillary thyroid cancer (PTC), but its recurrence risk has not been well stratified. We aimed to develop a risk stratification system for lateral neck recurrence in patients with pN1a PTC. Methods Patients with pN1a PTC who underwent thyroidectomy and unilateral central compartment dissection from 2000-2016 were enrolled. The association between number of central lymph node metastases (CLNMs) and lateral neck recurrence was comprehensively assessed using a Cox proportional hazards model with restricted cubic spline. Stratification was then performed based on CLNMs and other significant risk factors selected by multivariate analysis. Lateral neck recurrent-free survival (LRFS) rate of each stratification was estimated with Kaplan-Meier curve and comparison was performed using log-rank test. Results Ninety-six (3.8%) lateral neck recurrences were identified during a median follow-up of 62 months among a total of 2500 admitted cases. An increasing number of CLNMs was associated with compromised LRFS for up to 6 CLNMs (P < 0.001), and CLNMs > 3 indicated significantly worse 5-year LRFS than that of CLNM [less than or equai to] 3 (90.6% vs. 98.1%, P < 0.001). When stratification with CLNMs and primary tumor size (selected by multivariate analysis, HR (95%CI) = 4.225(2.460-7.256), P < 0.001), 5-year LRFS rates of high- (CLNMs > 3 and primary tumor size > 2 cm), intermediate- (CLNMs > 3 and primary tumor size 1-2 cm) and low-risk (primary tumor size [less than or equai to] 1 cm or CLNMs [less than or equai to] 3) groups were 78.5%, 90.0% and 97.9%, respectively (P < 0.05). Conclusions The number of CLNMs combined with primary tumor size seems to effectively stratify lateral neck recurrence risk for patients with pN1a PTC. Keywords: Papillary thyroid carcinoma, Lateral neck recurrence, Central lymph node metastasis, Primary tumor size