EP60 – The impact of occult lymph node metastasis for regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection

     

    Lee, Young Chan1
    1 Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea

     

    Background/ Purpose:
    The risk factor for regional recurrence after prophylactic central neck dissection (pCND) for preoperative nodal-negative papillary thyroid cancer (PTC) is controversial. We evaluated risk factors including clinicopathological characteristics and occult lymph node (LN) metastasis patterns for regional LN recurrence in PTC patients who underwent total thyroidectomy and bilateral pCND.

    Methods: This study enrolled 211 consecutive patients who underwent total thyroidectomy with bilateral pCND for PTC without evidence of central LN metastasis on preoperative imaging. Clinicopathological features and central LN metastasis patterns were analyzed for predicting regional recurrence. Multivariate Cox regression analysis was used to identify independent factors for recurrence.

    Results: Median follow-up time was 43 months (24-95 months). Ten patients (4.7%) showed regional LN recurrence. Among 10 patients, 2 recurred at the central LN compartment (20.0%) and 8 at the lateral LN compartment (80.0%). The estimated 5-year regional recurrence-free survival rate (RFS) was 95.2%. Tumor size ?1cm, central LN metastasis, LN ratio (LNR) and prelaryngeal LN metastasis were associated with regional recurrence in univariate analysis (p < 0.05). In multivariate analysis, LNR ? 0.26 was a significant risk factor for regional LN recurrence (odds ratio = 11.63, p=0.003). LNR ? 0.26 was an independent predictor of worse RFS on Cox -regression analysis. (hazard ratio = 11.49, p=0.002)

    Discussion & Conclusion: LN ratio ? 0.26 was an independent predictor of regional LN recurrence in PTC patients who underwent total thyroidectomy and bilateral pCND. A more careful surveillance of lateral neck is warranted in patients with LN ratio ? 0.26.

     

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