Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Abstract

Background and objectives: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.

Methods: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow-up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra-thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.

Results: Compared with the intra-thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease-specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow-up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.

Conclusions: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra-thyroid tumor group.

Keywords: cancer specific survival; lymph node dissection; radioactive iodine; thyroglobulin; total thyroidectomy.

Figure 1

Number of cases (left) and percentages (right) of 909 patients with papillary thyroid carcinoma (PTC), stratified according to presence of intra‐thyroid PTC, lymph node metastasis, soft tissue invasion, or distant metastasis.

Figure 2

Recurrence‐free survival curves of 909 patients with PTC in patients with intra‐thyroid PTC, lymph node metastasis, soft tissue invasion, or distant metastasis (P = 0.0001 between intra‐thyroid vs. lymph node metastasis, soft tissue invasion, and distant metastasis; lymph node metastasis vs. distant metastasis; soft tissue invasion vs. distant metastasis; P = 0.6673 between lymph node metastasis vs. soft tissue invasion).

Figure 3

Disease‐specific survival curves in the groups with intra‐thyroid, lymph node metastasis, soft tissue invasion, or distant metastasis of PTC (P = 0.0005 between intra‐thyroid vs. lymph node metastasis; P = 0.0001 between intra‐thyroid vs. soft tissue invasion, and intra‐thyroid vs. distant metastasis; lymph node metastasis vs. distant metastasis; soft tissue invasion vs. distant metastasis; P = 0.6261 between lymph node metastasis vs. soft tissue invasion).