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. 2017 Nov;87(5):566-571.
doi: 10.1111/cen.13378. Epub 2017 Jun 14.

Management and outcome of clinically evident neck recurrence in patients with papillary thyroid cancer

Laura Y Wang  1 , Jocelyn C Migliacci  1 , R Michael Tuttle  2 , Ashok R Shaha  1 , Jatin P Shah  1 , Snehal G Patel  1 , Ian Ganly  1
Affiliations

Management and outcome of clinically evident neck recurrence in patients with papillary thyroid cancer

Laura Y Wang et al. Clin Endocrinol (Oxf). 2017 Nov.

Abstract

Background: The aim of this study was to report our incidence of clinically evident neck recurrence, salvage neck management and subsequent outcomes in patients with papillary thyroid cancer. This is important to know so that patients with thyroid cancer can be properly counselled about the implications of recurrent disease and subsequent outcome.

Methods: An institutional database of 3664 patients with thyroid cancer operated between 1986 and 2010 was reviewed. Patients with nonpapillary histology and gross residual disease and those with distant metastases at presentation or distant metastases prior to nodal recurrence were excluded from the study. Of these, 99 (3.0%) patients developed clinically evident nodal recurrence. Details of recurrence and subsequent therapy were recorded for each patient. Subsequent disease-specific survival (sDSS), distant recurrence-free survival (sDRFS) and nodal recurrence-free survival (sNRFS) were determined from the date of first nodal recurrence using the Kaplan-Meier method.

Results: Of the 99 patients, 59% were female and 41% male. The median age was 41 years (range 5-91). The majority of patients had pT3/4 primary tumours (63%) and were pN+ (78%) at initial presentation. The median time to clinically evident nodal recurrence was 28 months (range: 3-264). Nodal recurrence occurred in the central neck in 15 (15%) patients, lateral neck in 74 (75%) patients and both in 10 (10%) patients. After salvage treatment, the 5-year sDSS was 97.4% from time of nodal recurrence. The 5-year sDRFS and sNRFS were 89.2% and 93.7%, respectively.

Conclusion: In our series, isolated clinically evident nodal recurrence occurred in 3.0% of patients. Such patients are successfully salvaged with surgery and adjuvant therapy with sDSS of 97.4% at 5 years.

Keywords: lymph nodes; neck recurrence; outcomes; papillary thyroid cancer; survival.

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Conflict of interest statement

Conflict of interest: The authors have no disclosures

Figures

Figure 1A
Figure 1A
Five year subsequent disease specific survival following salvage neck management
Figure 1B
Figure 1B
Five year subsequent distant recurrence free survival following salvage neck management
Figure 1C
Figure 1C
Five year subsequent neck recurrence free survival following salvage neck management
See this image and copyright information in PMC

References

    1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. The American journal of medicine. 1994;97(5):418–428. - PubMed
    1. Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001 Apr;86(4):1447–1463. - PubMed
    1. Randolph G, Duh Q, Heller K, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012 Nov;22(11):1144–1152. doi: 10.1089/thy.2012.0043. Epub 2012 Oct 1119. - DOI - PubMed
    1. Steward DL. Update in utility of secondary node dissection for papillary thyroid cancer. J Clin Endocrinol Metab. 2012 Oct;97(10):3393–3398. - PubMed
    1. Young S, Harari A, Smooke-Praw S, Ituarte P, Yeh M. Effect of reoperation on outcomes in papillary thyroid cancer. Surgery. 2013 Dec;154(6):1354–1361. doi: 10.1016/j.surg.2013.1306.1043. discussion 1361–1352. - DOI - PubMed

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