Volo, T.1;Soriano, M.1; Smith K.1; Goswamy. J.1; Nixon I.J.1; Mohan H.1; Jeannon J.P.1; Odell E.1; Hall G.1; Simo, R.1
1 Department of Otorhinolaryngology Head and Neck Surgery, Thyroid Oncology Unit, Guy’s and St Thomas Hospital NHS Foundation Trust, London, United Kingdom
Background: Patients with non-medullary thyroid cancer (NMTC) presenting with lateral neck metastases have a perceived worse prognosis. However, few studies have evaluated the association between primary tumour characteristics and the histopatological features of metastatic lymph nodes in NMTC in the lateral neck compartment and correlated this with oncological outcomes1,2.
Purpose: To determine the oncological outcomes of patients with NMTC who present with lateral neck metastases and correlate this finding with the primary tumour characteristics.
Methods: A retrospective case note review of patients with NMTC presenting with lateral neck metastases between 2002 and 2014 was performed. Data collection included primary tumour characteristics, TNM, multifocality, histological type, and the number and distribution of neck metastases.
Results: The study group included 310 patients. Totally 120 patients with NMTC presented with lateral neck metastases.15 (4,8% %) patients recurred in the neck and all could be salvaged with revision neck dissection followed by radioiodine ablation. 5 (1,6%) patients developed lung metastases and are alive with stable disease. 3 (1%) patients developed distant metastases and died from their disease, 7 (2,2%) died of other causes. These were all patients who had T4 primary tumours. Multifocality of the tumour (p<0,015), advanced T stage(p<0,003) and nodal involvement (p<0,001) influenced the DSS significantly. Conversely, number of lymph nodes involved, extranodal spread, level of lymph nodes involved did not have statistically significant impact on DSS.
Conclusion: The presence of lateral neck metastases at presentation only has an adverse outcome in patients with non-medullary thyroid cancer if the stage of primary tumour is a T4.
- Wang LY, Palmer FL, Nixon IJ, Tuttle RM, Shah JP, Patel SG, Shaha AR, Ganly I. Lateral Neck Lymph Node Characteristics Prognostic of Outcome in Patients with Clinically Evident N1b Papillary Thyroid Cancer. Ann Surg Oncol. 2015 Oct;22(11):3530-6.
- Lee HS, Park C, Kim SW, Song JW, Chun BK, Park TJ, Hong JC, Lee KD. Primary tumour characteristics predict the invasiveness of lymph node metastases in papillary thyroid carcinoma patients. J Laryngol Otol. 2016 Mar;130(3):302-8.