Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer

Background In papillary thyroid cancer, the role of lymph node dissection remains controversial, and staging systems consider metastatic lymph nodes as a binary entity. The purpose of this study was to determine a threshold lymph node ratio (LNR) that impacted disease-specific mortality (DSM). Metho...

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Bibliographic Details
Published in:Annals of surgical oncology 2013-06, Vol.20 (6), p.1906-1911
Main Authors: Schneider, David F., Chen, Herbert, Sippel, Rebecca S.
Format: Article
Language:English
Subjects:
Carcinoma - mortality
Carcinoma - pathology
Carcinoma, Papillary
Confidence Intervals
Endocrine Tumors
Female
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Male
Medicine
Medicine & Public Health
Middle Aged
Multivariate Analysis
Oncology
Proportional Hazards Models
SEER Program
Surgery
Surgical Oncology
Thyroid Cancer, Papillary
Thyroid Neoplasms - mortality
Thyroid Neoplasms - pathology
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Summary:Background In papillary thyroid cancer, the role of lymph node dissection remains controversial, and staging systems consider metastatic lymph nodes as a binary entity. The purpose of this study was to determine a threshold lymph node ratio (LNR) that impacted disease-specific mortality (DSM). Methods We utilized the surveillance, epidemiology, and end results (SEER) database to analyze adult patients who underwent thyroidectomy with lymph node dissection. A LNR (metastatic lymph nodes to total lymph nodes) was calculated after eliminating patients with less than three nodes collected. Kaplan–Meier estimates for DSM were plotted for LNRs and compared by the log rank test. The Cox proportional hazards model was used to evaluate LNR with other known clinical and pathologic determinants of prognosis. Results A total of 10,955 cases contained data on lymph nodes. Median follow-up time was 25 months (range 0–59 months), and the mean LNR was 0.28 ± 0.37. After comparing Kaplan–Meier survival estimates and overall DSM rates, we found that a LNR ≥0.42 best divided those with lymph node metastasis based on DSM ( p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-012-2802-8