J Pathol Transl Med.  2018 Sep;52(5):331-338. 10.4132/jptm.2018.08.07.

Prognostic Role of Metastatic Lymph Node Ratio in Papillary Thyroid Carcinoma

• Pyo JS
• Sohn JH
• Chang K

• KMID: 2422100
• DOI: http://doi.org/10.4132/jptm.2018.08.07

Abstract

BACKGROUND
The aim of this study is to elucidate the clinicopathological significances, including the prognostic role, of metastatic lymph node ratio (mLNR) and tumor deposit diameter in papillary thyroid carcinoma (PTC) through a retrospective review and meta-analysis.
METHODS
We categorized the cases into high (≥ 0.44) and low mLNR (< 0.44) and investigated the correlations with clinicopathological parameters in 64 PTCs with neck level VI lymph node (LN) metastasis. In addition, meta-analysis of seven eligible studies was used to investigate the correlation between mLNR and survival.
RESULTS
Among 64 PTCs with neck level VI LN metastasis, high mLNR was found in 34 PTCs (53.1%). High mLNR was significantly correlated with macrometastasis (tumor deposit diameter ≥ 0.2 cm), extracapsular spread, and number of metastatic LNs. Based on linear regression test, mLNR was significantly increased by the largest LN size but not the largest metastatic LN (mLN) size. High mLNR was not correlated with nuclear factor κB or cyclin D1 immunohistochemical expression, Ki-67 labeling index, or other pathological parameters of primary tumor. Based on meta-analysis, high mLNR significantly correlated with worse disease-free survival at the 5-year and 10-year follow-up (hazard ratio [HR], 4.866; 95% confidence interval [CI], 3.527 to 6.714 and HR, 5.769; 95% CI, 2.951 to 11.275, respectively).
CONCLUSIONS
Our data showed that high mLNR significantly correlated with worse survival, macrometastasis, and extracapsular spread of mLNs. Further cumulative studies for more detailed criteria of mLNR are needed before application in daily practice.

Keyword

Papillary thyroid carcinoma; Lymph node metastasis; Metastatic lymph node ratio; Prognosis; Meta-analysis

MeSH Terms

Cyclin D1
Disease-Free Survival
Follow-Up Studies
Linear Models
Lymph Nodes*
Neck
Neoplasm Metastasis
Prognosis
Retrospective Studies
Thyroid Gland*
Thyroid Neoplasms*
Cyclin D1

Figure

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  Fig. 1. Correlation between metastatic lymph node ratio (mLNR) and largest lymph node size (A) and largest metastatic lymph node (mLN) size (B) based on linear regression.

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  Fig. 2. Flow chart of study search and selection methods.

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  Fig. 3. Forest plot diagram for the correlation between high metastatic lymph node ratio and disease-free survival at the 5-year (A) and 10-year (B) follow-up.[8,10-12,14,16,17,26] CI, confidence interval.

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