scholarly journals Papillary Thyroid Carcinomas with Cervical Lymph Node Metastases Can Be Stratified into Clinically Relevant Prognostic Categories Using Oncogenic BRAF, the Number of Nodal Metastases, and Extra-Nodal Extension

Thyroid ◽  
2012 ◽  
Vol 22 (6) ◽  
pp. 575-584 ◽  
Author(s):  
Julio Ricarte-Filho ◽  
Ian Ganly ◽  
Michael Rivera ◽  
Nora Katabi ◽  
Weimin Fu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Nodal Metastases ◽  
Papillary Thyroid ◽  
Cervical Lymph Node Metastases ◽  
Thyroid Carcinomas ◽  
Node Metastases

Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer

2015 ◽  
Vol 33 (21) ◽  
pp. 2370-2375 ◽  
Author(s):  
Mohamed Abdelgadir Adam ◽  
John Pura ◽  
Paolo Goffredo ◽  
Michaela A. Dinan ◽  
Shelby D. Reed ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Metastases ◽  
Cervical Lymph Node ◽  
Cancer Staging ◽  
Nodal Metastases ◽  
Papillary Thyroid ◽  
Cervical Lymph Node Metastases ◽  
Node Metastases

Purpose Cervical lymph node metastases are recognized as a prognostic indicator only in patients age 45 years or older with papillary thyroid cancer (PTC); patients younger than age 45 years are perceived to have low-risk disease. The current American Joint Committee on Cancer staging for PTC in patients younger than age 45 years does not include cervical lymph node metastases. Our objective was to test the hypothesis that the presence and number of cervical lymph node metastases have an adverse impact on overall survival (OS) in patients younger than age 45 years with PTC. Patients and Methods Adult patients younger than age 45 years undergoing surgery for stage I PTC (no distant metastases) were identified from the National Cancer Data Base (NCDB; 1998-2006) and from SEER 1988-2006 data. Multivariable models were used to examine the association of OS with the presence of lymph node metastases and number of metastatic nodes. Results In all, 47,902 patients in NCDB (11,740 with and 36,162 without nodal metastases) and 21,855 in the SEER database (5,188 with and 16,667 without nodal metastases) were included. After adjustment, OS was compromised for patients with nodal metastases compared with patients who did not have them (NCDB: hazard ratio (HR), 1.32; 95% CI, 1.04 to 1.67; P = .021; SEER: HR, 1.29; 95% CI, 1.08 to 1.56; P = .006). After adjustment, increasing number of metastatic lymph nodes was associated with decreasing OS up to six metastatic nodes (HR, 1.12; 95% CI, 1.01 to 1.25; P = .03), after which more positive nodes conferred no additional mortality risk (HR, 0.99; 95% CI, 0.99 to 1.05; P = .75). Conclusion Our results suggest that cervical lymph node metastases are associated with compromised survival in young patients, warranting consideration of revised American Joint Committee on Cancer staging. A change point of six or fewer metastatic lymph nodes seems to carry prognostic significance, thus advocating for rigorous preoperative screening for nodal metastases.

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