Korean J Otorhinolaryngol-Head Neck Surg.  2022 Aug;65(8):448-456. 10.3342/kjorl-hns.2021.01004.

Risk Factors for Local Recurrence in Patients With N1b Papillary Thyroid Carcinoma

Affiliations
  • 1Department of Otorhinolaryngology-Head, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 2Biomedical Research Institude, Pusan National University Hospital, Busan, Korea
  • 3Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
  • 4Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 5Department of Statistics, Pusan National University, Busan, Korea

Abstract

Background and Objectives
Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.
Subjects and Method
This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS).
Results
A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant.
Conclusion
PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.

Keyword

Lymphatic metastasis; Prognosis; Recurrences; Risk factors; Thyroid neoplasm
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