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HERO ID
9909694
Reference Type
Journal Article
Title
Significance of size of lymph node metastasis on postsurgical stimulated thyroglobulin levels after prophylactic unilateral central neck dissection in papillary thyroid carcinoma
Author(s)
Lang, BH; Tang, AH; Wong, KP; Shek, TW; Wan, KY; Lo, CY
Year
2012
Is Peer Reviewed?
Yes
Journal
Annals of Surgical Oncology
ISSN:
1068-9265
Volume
19
Issue
11
Page Numbers
3472-3478
Language
English
PMID
22565664
DOI
10.1245/s10434-012-2385-4
Abstract
BACKGROUND:
The prognostic significance of size of central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) remains unknown. Because postsurgical detectable stimulated thyroglobulin (DsTg) after radioiodine ablation may imply persistent or recurrent disease, we evaluated the association between size of CLNM and rate of DsTg in patients with PTC who underwent unilateral prophylactic central neck dissection.
METHODS:
To be eligible for analysis, the prophylactic central neck dissection specimen with <3 central lymph nodes (CLNs) or size of CLNM ≥1 cm as measured under the microscope was excluded. Of 132 specimens, 89 (67.4%) were eligible. Forty patients (44.9%) had no metastasis or pN0, 20 (22.5%) had micrometastasis (<2 mm) or pN1mic and 29 (32.6%) had macrometastasis (≥2 mm) or pN1mac. Postablation sTg level was measured 9 months after surgery. A multivariable analysis was conducted to identify independent factors for postablation DsTg.
RESULTS:
Larger-sized CLNM correlated significantly with younger age (p = 0.028), greater number of CLN retrieved (p = 0.016), greater number of metastatic CLN excised (p < 0.001), higher metastatic CLN ratio (p = 0.006) and postablation sTg level (p = 0.012). In the multivariable analysis, after adjusting for tumor size and metastatic CLN ratio, size of CLNM was an independent predictor of postablation DsTg (odds ratio 1.56, 95% confidence interval 1.09-2.24, p = 0.015). Relative to pN0, the odds ratios for postablation DsTg in pN1mic and pN1mac were 2.53 (95% confidence interval 0.35-19.00, p = 0.351) and 5.81 (95% confidence interval 1.22-27.70, p = 0.027), respectively.
CONCLUSIONS:
Size of CLNM was an independent factor for DsTg 9 months after surgery. Patients with pN1mac were almost 6 times more likely to have postablation DsTg than those with pN0 or pN1mic.
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