Lymph node ratio as a tool to stratify patients with N1b papillary thyroid cancer.
Disease-specific mortality
Lymph node ratio
Overall survival
Papillary thyroid cancer
SEER
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
16 Aug 2023
16 Aug 2023
Historique:
received:
02
03
2023
accepted:
28
07
2023
medline:
17
8
2023
pubmed:
16
8
2023
entrez:
16
8
2023
Statut:
epublish
Résumé
The prognostic significance of lymph node ratio (LNR) in N1b papillary thyroid cancer is unclear. Therefore, the impact of LNR on disease-specific mortality (DSM) and overall survival (OS) in patients with N1b papillary thyroid cancer (PTC) needs to be defined. We used the Surveillance, Epidemiology, and End Results (SEER) database of patients who had undergone thyroidectomy and lymph node dissection. Factors associated with DSM and OS were analyzed and identified using univariate and multivariate Cox proportional risk models. X-tile software was used to find the best cutoff value of LNR. Kaplan-Meier estimates for DSM were plotted for LNR and were compared with the log-rank test. The ROC curve evaluated the validity of the model. A total of 3223 patients with N1b PTC were identified in the SEER database between 1975 and 2019. The best cutoff value for LNR was 0.6. The multivariate Cox proportional risk model showed that age, race, T3/T4 classification, distant metastasis, extent of surgery, number of metastatic lymph nodes, and LNR > 0.6 were independent risk factors for DSM (all p < 0.05). Age, sex, T4 classification, distant metastasis, extent of surgery, and LNR > 0.6 were independent risk factors for OS (all p < 0.05). The Kaplan-Meier method plotted a cumulative risk curve and showed that patients with LNR > 0.6 had a significantly higher risk of DSM than patients with LNR ≤ 0.6 (p = 0.002). LNR was a powerful predictor of DSM and OS in N1b PTC patients. LNR could be a useful tool for the stratification of PTC patients with lateral neck metastases.
Sections du résumé
BACKGROUND
BACKGROUND
The prognostic significance of lymph node ratio (LNR) in N1b papillary thyroid cancer is unclear. Therefore, the impact of LNR on disease-specific mortality (DSM) and overall survival (OS) in patients with N1b papillary thyroid cancer (PTC) needs to be defined.
METHODS
METHODS
We used the Surveillance, Epidemiology, and End Results (SEER) database of patients who had undergone thyroidectomy and lymph node dissection. Factors associated with DSM and OS were analyzed and identified using univariate and multivariate Cox proportional risk models. X-tile software was used to find the best cutoff value of LNR. Kaplan-Meier estimates for DSM were plotted for LNR and were compared with the log-rank test. The ROC curve evaluated the validity of the model.
RESULTS
RESULTS
A total of 3223 patients with N1b PTC were identified in the SEER database between 1975 and 2019. The best cutoff value for LNR was 0.6. The multivariate Cox proportional risk model showed that age, race, T3/T4 classification, distant metastasis, extent of surgery, number of metastatic lymph nodes, and LNR > 0.6 were independent risk factors for DSM (all p < 0.05). Age, sex, T4 classification, distant metastasis, extent of surgery, and LNR > 0.6 were independent risk factors for OS (all p < 0.05). The Kaplan-Meier method plotted a cumulative risk curve and showed that patients with LNR > 0.6 had a significantly higher risk of DSM than patients with LNR ≤ 0.6 (p = 0.002).
CONCLUSION
CONCLUSIONS
LNR was a powerful predictor of DSM and OS in N1b PTC patients. LNR could be a useful tool for the stratification of PTC patients with lateral neck metastases.
Identifiants
pubmed: 37584830
doi: 10.1007/s00423-023-03033-w
pii: 10.1007/s00423-023-03033-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
315Subventions
Organisme : Henan Health Commission
ID : 2018020490
Organisme : Henan Health Commission
ID : 2018020490
Organisme : Henan Health Commission
ID : 2018020490
Organisme : Henan Health Commission
ID : 2018020490
Organisme : Henan Health Commission
ID : 2018020490
Organisme : Henan Health Commission
ID : 2018020490
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71(1):7–33. https://doi.org/10.3322/caac.21654
doi: 10.3322/caac.21654
pubmed: 33433946
Pereira M, Williams VL, Hallanger Johnson J, Valderrabano P (2020) Thyroid cancer incidence trends in the United States: association with changes in professional guideline recommendations. Thyroid 30(8):1132–1140. https://doi.org/10.1089/thy.2019.0415
doi: 10.1089/thy.2019.0415
pubmed: 32098591
Park S, Kim WG, Song E et al (2017) Dynamic risk stratification for predicting recurrence in patients with differentiated thyroid cancer treated without radioactive iodine remnant ablation therapy. Thyroid 27(4):524–530. https://doi.org/10.1089/thy.2016.0477
doi: 10.1089/thy.2016.0477
pubmed: 27869547
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133. https://doi.org/10.1089/thy.2015.0020
doi: 10.1089/thy.2015.0020
pubmed: 26462967
pmcid: 4739132
Nixon IJ, Wang LY, Palmer FL et al (2014) The impact of nodal status on outcome in older patients with papillary thyroid cancer. Surgery 156(1):137–146. https://doi.org/10.1016/j.surg.2014.03.027
doi: 10.1016/j.surg.2014.03.027
pubmed: 24878458
Vrachimis A, Wenning C, Gerss J et al (2015) Not all DTC patients with N positive disease deserve the attribution “high risk” 5 Contribution of the MSDS trial. J Surg Oncol 112(1):9–14. https://doi.org/10.1002/jso.23948
doi: 10.1002/jso.23948
pubmed: 26074402
Sapuppo G, Palermo F, Russo M et al (2017) Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome. J Endocrinol Invest 40(12):1355–1363. https://doi.org/10.1007/s40618-017-0714-y
doi: 10.1007/s40618-017-0714-y
pubmed: 28646475
Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD (2011) Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck 33(5):645–649. https://doi.org/10.1002/hed.21504
doi: 10.1002/hed.21504
pubmed: 20687168
Wang Z, Tang C, Wang Y, Yin Z, Rixiati Y (2022) Inclusion of the number of metastatic lymph nodes in the staging system for medullary thyroid cancer: validating a modified American joint committee on cancer tumor-node-metastasis staging system. Thyroid 32(5):536–543. https://doi.org/10.1089/thy.2021.0571
doi: 10.1089/thy.2021.0571
pubmed: 35350868
Schneider DF, Chen H, Sippel RS (2013) Impact of lymph node ratio on survival in papillary thyroid cancer. Ann Surg Oncol 20(6):1906–1911. https://doi.org/10.1245/s10434-012-2802-8
doi: 10.1245/s10434-012-2802-8
pubmed: 23263904
Arianpoor A, Asadi M, Amini E, Ziaeemehr A, Ahmadi Simab S, Zakavi SR (2020) Investigating the prevalence of risk factors of papillary thyroid carcinoma recurrence and disease-free survival after thyroidectomy and central neck dissection in Iranian patients. Acta Chir Belg 120(3):173–178. https://doi.org/10.1080/00015458.2019.1576447
doi: 10.1080/00015458.2019.1576447
pubmed: 31237189
Patel SG, Amit M, Yen TC et al (2013) Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research. Br J Cancer 109(8):2087–2095. https://doi.org/10.1038/bjc.2013.570
doi: 10.1038/bjc.2013.570
pubmed: 24064974
pmcid: 3798966
Kim HI, Kim TH, Choe JH et al (2017) Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size. Cancer Med 6(10):2244–2251. https://doi.org/10.1002/cam4.1160
doi: 10.1002/cam4.1160
pubmed: 28857489
pmcid: 5633551
Kim HI, Kim K, Park SY et al (2018) Refining the eighth edition AJCC TNM classification and prognostic groups for papillary thyroid cancer with lateral nodal metastasis. Oral Oncol 78:80–86. https://doi.org/10.1016/j.oraloncology.2018.01.021
doi: 10.1016/j.oraloncology.2018.01.021
pubmed: 29496063
Smith BD, Oyekunle TO, Thomas SM, Puscas L, Rocke DJ (2020) Association of lymph node ratio with overall survival in patients with metastatic papillary thyroid cancer. JAMA Otolaryngol Head Neck Surg 146(10):962–964. https://doi.org/10.1001/jamaoto.2020.2053
doi: 10.1001/jamaoto.2020.2053
pubmed: 32761147
pmcid: 7411928
Suzuki HKY, Hanai N, Nishikawa D, Beppu S, Mikami S, Hasegawa Y (2018) Lymph node density in papillary thyroid carcinoma is a prognostic factor after adjusting for pathological stage. Oncotarget Oncotarget 9(42):26670–26678
doi: 10.18632/oncotarget.25453
pubmed: 29928477
Haddad RI, Bischoff L, Ball D et al (2022) Thyroid carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 20(8):925–951
doi: 10.6004/jnccn.2022.0040
pubmed: 35948029