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Published Online: 12 February 2010

Clinical Risk Factors Associated with Cervical Lymph Node Recurrence in Papillary Thyroid Carcinoma

Publication: Thyroid
Volume 20, Issue Number 2

Abstract

Background: Recurrence of regional cervical lymph nodes in patients with papillary thyroid carcinoma (PTC) is not uncommon, and is an important factor affecting the quality of life. The aims of this study are to investigate the risk factors that are associated with regional lymph node recurrence by comparing a group of patients with regional lymph node recurrence with a group without lymph node recurrence, and to analyze the clinical characteristics of recurrent regional lymph nodes in PTC.
Methods: A retrospective analysis was performed on 189 patients who underwent surgery for PTC. By comparing a group with recurrent cervical lymph nodes (n = 33) with a group without recurrent cervical lymph nodes (n = 156), the risk factors for cervical lymph node recurrence were investigated and the clinical characteristics of recurrent cervical lymph nodes were analyzed.
Results: Tumor size >2 cm, presence of extrathyroid tumor spread, high T stage, and presence of lymph node metastasis were associated with regional lymph node recurrence in univariate analysis (p < 0.05). Among them, only the N stage was significantly associated with regional recurrence in multivariate analysis (p < 0.05). The disease-free survival period was shorter in the lymph node metastasis–positive group, and the 10-year disease-free survival rate was 77.8% in the lymph node metastasis–negative group and 57.9% in the lymph node metastasis–positive group (p < 0.05). Among 130 patients without lymph node metastasis, regional recurrence occurred in 13 patients (10%), and the frequent levels of regional recurrence were levels II–IV of ipsilateral neck. In the patients with lymph node metastasis, the frequent levels were levels IV–VI of ipsilateral side and level II of the contralateral side.
Conclusion: Considering the low incidence of regional lymph node recurrence and the levels with frequent regional recurrence in patients without lymph node metastasis, elective neck dissection in all cases of total thyroidectomy may be immoderate. However, if any risk factors for regional recurrence, including large tumor size, presence of extrathyroid spread, high T stage, and presence of lymph node metastasis, are detected by preoperative and intraoperative evaluation, a systematic compartment-oriented lymphadenectomy should be considered because of the high possibility of regional recurrence.

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Published In

cover image Thyroid®
Thyroid
Volume 20Issue Number 2February 2010
Pages: 147 - 152
PubMed: 19785522

History

Published online: 12 February 2010
Published in print: February 2010
Published ahead of print: 28 September 2009

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Seung-Kuk Baek
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Kwang-Yoon Jung
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Sun-Mook Kang
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Soon-Young Kwon
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Jeong-Soo Woo
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Seung-Hyun Cho
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.
Eun-Jae Chung
Department of Otolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea.

Notes

Address correspondence to:Kwang-Yoon Jung, M.D., Ph.D.Department of Otolaryngology–Head and Neck SurgeryKorea University College of Medicine
Anam-dong 5-ga 126-1, Seongbuk-guSeoul 136-705South Korea
E-mail: [email protected]

Disclosure Statement

The authors declare that no competing financial interests exist.

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