The prognostic value of Central Lymph Node Yield and Ratio in Papillary Thyroid Carcinoma Patients who Underwent Thyroidectomy with Prophylactic Central Compartment Neck Dissection
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We evaluated the prognostic value of central lymph node yield (LNY) and lymph node ratio (LNR) during thyroidectomy with pCCND on the recurrence free survival (RFS) in papillary thyroid carcinoma patients.
We retrospectively reviewed 1762 patients of classic PTC who underwent thyroidectomy with pCCND between 2009 and 2012 at Seoul St. Mary’s Hospital, by a single surgeon. LNY was separated into 2 groups (low: 1-7 nodes; high: 8+ nodes). LNR was divided 2 groups (low : <0.15, high: ?0.15). The number of metastatic lymph nodes were also separated into 2 groups (low : 1-4 nodes; high 5+ nodes).
Of 1762 patients, 1454 patients were female and median age was 46 years. The median follow up period was 76 months [0 – 110]. The mean LNY and LNR were 8.73 and 0.15, respectively. The recurrences were observed in 33 cases (1.87%). The estimated RFS of total patients was 108.2 months. However, since LNY and LNR had multicollinearity with the metastatic lymph nodes, we removed the metastatic lymph nodes or separated the LNY and LNR parameters when performing multivariate cox regression. It has been shown that age, extra-thyroidal extension (ETE), cancer size, multiplicity, the metastatic lymph nodes (HR 5.697 [2.795 – 11.614]) LNY (HR 2.251 [1.019 – 4.968]), and LNR (HR 2.312 [1.073 – 4.982]) were associated with RFS.
Of the nodal factors, the amount of metastatic lymph nodes, LNY and LNR factors have a negative effect on RFS for PTC patients who underwent thyroidectomy with pCCND.
Two Approaches to Level 5 Neck Dissection
- Jeff Blumberg