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Papillary thyroid cancer outcomes have significantly improved over time
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LAKE BUENA VISTA, Fla. — Factors such as decreased extent of lymph node involvement, improved diagnostics and more complete surgical neck dissection have led to significantly improved clinical outcomes among patients with papillary thyroid carcinoma and cervical lymph node metastasis, according to study results presented at the International Thyroid Congress.
“The incidence of thyroid cancer has increased largely due to small papillary thyroid cancers detected after the introduction of highly sensitive ultrasonography,” Min Ji Jeon, MD, of the Asan Medical Center at University of Ulsan College of Medicine in South Korea, said during a presentation. “The characteristics of cervical lymph node metastasis are also changing, particularly in papillary thyroid cancer. We can now detect small, subclinical metastatic lymph nodes.”
The number and size of metastatic lymph nodes have been proposed as potential prognostic factors in patients with papillary thyroid carcinoma and cervical lymph node metastasis (stage N1).
Jeon and colleagues sought to evaluate changes in N1 papillary thyroid carcinoma characteristics, as well as changes in the clinical outcome over time. Further, they aimed to confirm the prognostic value of the number and size of metastatic lymph nodes.
The study included data from 1,815 patients with N1 papillary thyroid cancers diagnosed between 1997 and 2011. The researchers classified patients into three risk groups based on the number and size of metastatic lymph nodes: very low risk (≤ 5 lymph nodes < 0.2 cm), low risk (≤ 5 lymph nodes ≥ 0.2 cm) and high risk (> 5 lymph nodes).
Over time, metastatic lymph nodes became smaller and the number of metastatic lymph nodes — which represent the extent of lymph node involvement and the completeness of surgery — significantly decreased.
Further, the size of primary tumors decreased significantly over time, even after the exclusion of patients with papillary thyroid microcarcinoma.
The proportion of patients with excellent response to surgery significantly increased, from 33% to 67% (P < .001). These improvements appeared more noticeably in the low- and high-risk groups than in the very low-risk group.
Seventy-six percent of patients had no evidence of disease at the latest reporting period.
DFS 5 years post-surgery also improved over time, from 73% to 91% (P < .001).
However, subgroup analyses showed that increases in DFS over time occurred only in low- and high-risk groups.
“These findings suggest that more complete surgery might be responsible for improvements on clinical outcomes in these patient groups,” Jeon said. “The changes in clinical outcomes can largely be related to earlier detection of papillary thyroid cancers and changes in treatment. As such, the number and size of metastatic lymph nodes are a valuable indicator of the risk for recurrence in patients with N1 papillary thyroid cancer.” – by Cameron Kelsall
Reference:
Jeon M, et al. Oral Abstract 74. Presented at: International Thyroid Congress; Oct. 18-23, 2015; Lake Buena Vista, Fla.
Disclosure: The researchers report no relevant financial disclosures.