Loading…
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...
Saved in:
| Published in: | Annals of surgical oncology 2013-06, Vol.20 (6), p.1906-1911 |
|---|---|
| Main Authors: | , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites Items that cite this one |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | cdi_FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3 |
|---|---|
| cites | cdi_FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3 |
| container_end_page | 1911 |
| container_issue | 6 |
| container_start_page | 1906 |
| container_title | Annals of surgical oncology |
| container_volume | 20 |
| creator | Schneider, David F. Chen, Herbert Sippel, Rebecca S. |
| description | 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
|
| doi_str_mv | 10.1245/s10434-012-2802-8 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3609925</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2977024371</sourcerecordid><originalsourceid>FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3</originalsourceid><addsrcrecordid>eNp1kUtP3DAUhS1UxGPgB7CpLLFhk3L9jLOpBCNKkUaAKF1bTuIwRkkc7GSk-ff1MBRRpK5s-X4-9557EDoh8I1QLs4jAc54BoRmVAHN1A46ICK9cKnIl3QHqbKCSrGPDmN8BiA5A7GH9imjkhXAD9DlTTeYasS-wYt1Nyzxra8tfjCj89j3-NcUVm5lWux6fG8G17YmrPHjch28q_Hc9JUNR2i3MW20x2_nDP3-cfU4_5kt7q5v5heLrBJMjhmlrKFCqpIoIhtbSya5qouSkZzzivA8b0AaUUNJC6moKpuCW5HXJQWQjNdshr5vdYep7Gxd2X4MptVDcF0aSnvj9L-V3i31k19pJqEoqEgCZ28Cwb9MNo66c7GyyVNv_RQ1YYKlhRJQCT39hD77KfTJ3iuVp_0SSBTZUlXwMQbbvA9DQG8S0tuEdEpIbxLSG-WvH128__gbSQLoFoip1D_Z8KH1f1X_AIhqmY8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1353768110</pqid></control><display><type>article</type><title>Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer</title><source>Springer Nature</source><creator>Schneider, David F. ; Chen, Herbert ; Sippel, Rebecca S.</creator><creatorcontrib>Schneider, David F. ; Chen, Herbert ; Sippel, Rebecca S.</creatorcontrib><description>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
< 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (
p
< 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68–11.18,
p
< 0.01).
Conclusions
LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-012-2802-8</identifier><identifier>PMID: 23263904</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>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</subject><ispartof>Annals of surgical oncology, 2013-06, Vol.20 (6), p.1906-1911</ispartof><rights>Society of Surgical Oncology 2012</rights><rights>Society of Surgical Oncology 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3</citedby><cites>FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23263904$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schneider, David F.</creatorcontrib><creatorcontrib>Chen, Herbert</creatorcontrib><creatorcontrib>Sippel, Rebecca S.</creatorcontrib><title>Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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
< 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (
p
< 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68–11.18,
p
< 0.01).
Conclusions
LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.</description><subject>Carcinoma - mortality</subject><subject>Carcinoma - pathology</subject><subject>Carcinoma, Papillary</subject><subject>Confidence Intervals</subject><subject>Endocrine Tumors</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Oncology</subject><subject>Proportional Hazards Models</subject><subject>SEER Program</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Thyroid Cancer, Papillary</subject><subject>Thyroid Neoplasms - mortality</subject><subject>Thyroid Neoplasms - pathology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp1kUtP3DAUhS1UxGPgB7CpLLFhk3L9jLOpBCNKkUaAKF1bTuIwRkkc7GSk-ff1MBRRpK5s-X4-9557EDoh8I1QLs4jAc54BoRmVAHN1A46ICK9cKnIl3QHqbKCSrGPDmN8BiA5A7GH9imjkhXAD9DlTTeYasS-wYt1Nyzxra8tfjCj89j3-NcUVm5lWux6fG8G17YmrPHjch28q_Hc9JUNR2i3MW20x2_nDP3-cfU4_5kt7q5v5heLrBJMjhmlrKFCqpIoIhtbSya5qouSkZzzivA8b0AaUUNJC6moKpuCW5HXJQWQjNdshr5vdYep7Gxd2X4MptVDcF0aSnvj9L-V3i31k19pJqEoqEgCZ28Cwb9MNo66c7GyyVNv_RQ1YYKlhRJQCT39hD77KfTJ3iuVp_0SSBTZUlXwMQbbvA9DQG8S0tuEdEpIbxLSG-WvH128__gbSQLoFoip1D_Z8KH1f1X_AIhqmY8</recordid><startdate>20130601</startdate><enddate>20130601</enddate><creator>Schneider, David F.</creator><creator>Chen, Herbert</creator><creator>Sippel, Rebecca S.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130601</creationdate><title>Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer</title><author>Schneider, David F. ; Chen, Herbert ; Sippel, Rebecca S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Carcinoma - mortality</topic><topic>Carcinoma - pathology</topic><topic>Carcinoma, Papillary</topic><topic>Confidence Intervals</topic><topic>Endocrine Tumors</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Oncology</topic><topic>Proportional Hazards Models</topic><topic>SEER Program</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Thyroid Cancer, Papillary</topic><topic>Thyroid Neoplasms - mortality</topic><topic>Thyroid Neoplasms - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schneider, David F.</creatorcontrib><creatorcontrib>Chen, Herbert</creatorcontrib><creatorcontrib>Sippel, Rebecca S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schneider, David F.</au><au>Chen, Herbert</au><au>Sippel, Rebecca S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2013-06-01</date><risdate>2013</risdate><volume>20</volume><issue>6</issue><spage>1906</spage><epage>1911</epage><pages>1906-1911</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>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
< 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (
p
< 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68–11.18,
p
< 0.01).
Conclusions
LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23263904</pmid><doi>10.1245/s10434-012-2802-8</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2013-06, Vol.20 (6), p.1906-1911 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3609925 |
| source | Springer Nature |
| 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 |
| title | Impact of Lymph Node Ratio on Survival in Papillary Thyroid Cancer |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T09%3A16%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20Lymph%20Node%20Ratio%20on%20Survival%20in%20Papillary%20Thyroid%20Cancer&rft.jtitle=Annals%20of%20surgical%20oncology&rft.au=Schneider,%20David%20F.&rft.date=2013-06-01&rft.volume=20&rft.issue=6&rft.spage=1906&rft.epage=1911&rft.pages=1906-1911&rft.issn=1068-9265&rft.eissn=1534-4681&rft_id=info:doi/10.1245/s10434-012-2802-8&rft_dat=%3Cproquest_pubme%3E2977024371%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c536t-223f2568b1816fed63648d9b31744c1477f06a5d0b296828bf94e57db200634d3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1353768110&rft_id=info:pmid/23263904&rfr_iscdi=true |