OP73 – Outcome of 69 patients with differentiated thyroid cancer and lateral lymph node metastases

      Califano, Inés1; Zund, Santiago2, Carrizo, Fernando3 1 Department of Endocrinology, Roffo Cancer Center, University of Buenos Aires, Buenos Aires, Argentina 2 Department of Head & Neck Surgery, Roffo Cancer Center, University of Buenos Aires, Buenos Aires, Argentina 3 Department of Pathology, Roffo Cancer Center, University of Buenos Aires, Buenos Aires, Argentina   Background/Purpose: As impact on recurrence and mortality of lateral neck has not been extensively studied, we aimed to assess the outcome of our population of differentiated thyroid cancer (DTC) patients with lateral neck lymph nodes (LNLN). Methods: Retrospective study of patients with DTC with LNLN, from 2003 to 2016. All of them received total thyroidectomy, central and lateral lymph node dissection and high dose radioiodine ablation (?100 mCi). Clinico-pathological characteristics, stratification with AJCC/UICC 7ed, American Thyroid Association risk of recurrence and dynamic risk of recurrence were evaluated. Statistical analysis: SPSS Windows 19.0. Results: Mean follow up 61,8 (±46) months. Final outcomes were known in 61 cases (88,4%). Twenty one patients (34%) were free of disease, 14 (22,9%) had indeterminate response, 9 (14,7%) incomplete biochemical response, and 17 (27,8%) had incomplete structural response. Twelve patients (19,7%) showed locorregional recurrence; 4 showed distant metastases on follow up, and 1 presented both. After excluding patients with gross extrathyroid extension (ETE) and/or initial distant metastases, 53 patients were taken for analysis, of which final status was known in 44. Nine patients (19%) presented structural recurrence. Status on last evaluation: 2 patients died (4,5%), structural persistence 3 (6,8%), biochemical incomplete response 7 (15,9%), indeterminate response 11 (25%) and, excellent response 21 (47,7%). Discussion & Conclusions: 1) LNLN were associated with recurrence in over one third of the population, 2) After excluding ETE and M1, structural incomplete response rate was 19%;  3) Preablation Tg levels were higher in patients with structural recurrence, underscoring their prognostic value, 4) Adverse LnLN characteristics were more frequent in patients with structural recurrence, although it did not reach statistical difference.   References:
    1. Clain JB, Scherl S, Dos Reis L, Turk A, Wenig BM, et al. Extrathyroidal extension predicts extranodal extension in patients with positive lymph nodes: An important association that may affect clinical management. Thyroid 2014;24(6):951-957
    2. Eskander A, Merdad M, Freeman JL, Witterick IJ. Pattern of spread to the lateral neck in metastatic well-differentiated thyroid cancer: A systematic review and meta-analysis. Thyroid 2013;23(5):583-592
    3. Giordano D, Frasoldati A, Kasperbauer JL, Gabrielli E, Pernice C, et al. Lateral neck recurrence from papillary thyroid carcinoma: Predictive factors and prognostic significance. Laryngoscope 2015;125:2226-2231 Ito Y, Kudo T, Takamura Y, Kobayashi K, Miya A, et al. Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection. World J Surg 2012;36:593-597
    4. Joo J-y, Jin J, Seo ST, Lim YC, Rha K-S, et al. Recurrence in regional lymph nodes after total thyroidectomy and neck dissection in patients with papillary thyroid cancer. Oral Oncol 2015;51:164-169
    5. Kim HJ, Park HK, Byun BW, Suh K, Yoo MH, et al. Number of tumor foci as predictor of lateral lymph node metastasis in papillary thyroid carcinoma. Head Neck 2015;37:650-654
    6. Merdad M, Eskander A, Kroeker T, Freeman JL. Metastatic papillary thyroid cancer with lateral neck disease: Pattern of spread by level. Head Neck 2013;35:1439-1442
    7. Moritani S. Impact of invasive extranodal extension on the prognosis of patients with papillary thyroid carcinoma. Thyroid 2014;24(12):1779-1783
    8. Nam IC, Park JO, Joo YH, Cho KJ, Kim MS. Pattern and predictive factors of regional lymph node metastasis in papillary thyroid carcinoma: A prospective study. Head Neck 2013;35:40-45
    9. Randolph GW, Duh Q-Y, Heller KS, LiVolsi VA, Mandell SJ, 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;22(11):1144-1152


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