Gender, lymph node ratio linked to papillary thyroid carcinoma recurrence

CORONADO, Calif. — Elevated lymph node ratio and male gender were strongly associated with poorer disease-free survival among patients with papillary thyroid carcinoma, according to study results presented at the American Thyroid Association Annual Meeting.

According to researchers, lymph node metastasis involving the central neck is a hallmark of risk for papillary thyroid cancer recurrence.

To evaluate the influence of central compartment nodal involvement on DFS in patients with papillary thyroid cancer, Ryaz Chagpar, MD, from the department of endocrine surgery in the Endocrinology and Metabolism Institute at Cleveland Clinic, and colleagues reviewed single-institution data from 415 patients with papillary thyroid cancer who had central neck lymph nodes sent for pathologic assessment from 1999 to 2012.

Chagpar and colleagues used univariate and Cox multivariate analyses to illustrate clinicopathologic factors linked to DFS.

The researchers pathologically confirmed positive nodal disease in 72.3% of patients. Among cohort patients, 75.4% received a formal central neck dissection, 27.5% of whom received nodal clearance of the lateral neck as well. The outstanding 24.6% of cohort patients received sampling of suspicious lymph nodes, 31% of whom were diagnosed positive on final pathology.

The median follow-up duration was 36 months.

According to study results, 6.5% of patients experienced a recurrence, predominantly either local (37%) or regional (40.7%). Chagpar and colleagues observed recurrence in 2.7% of patients with node-negative disease, 5.3% of patients with N1a and 13.1% of patients with N1b disease.

After univariate analysis, researchers observed that male gender, tumor size greater than 2 cm, extrathyroidal extension, lymphovascular invasion, positive margins and receipt of adjuvant radioactive iodine were positively linked to recurrence. In addition, patients with a positive lymph node ratio ≥0.4, extranodal invasion or nodal spread to the lateral compartment were at increased risk for lower DFS (log-rank, P<.05 for all).

However, after multivariate analysis, Chagpar and colleagues observed that only lymph node ratio ≥0.4 (HR=3.2; 95% CI, 1.2-9.2) and male gender (HR=3.7; 95% CI, 1.4-10.4) remained constant predictors of recurrence.

For more information:

Chagpar R. Poster #56. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.