Incidental Node Metastasis as an Independent Factor of Worse Disease-Free Survival in Patients with Papillary Thyroid Carcinoma
Introduction: Papillary thyroid carcinoma (PTC) have high node metastasis rates. Occasionally after thyroidectomy, the pathological report reveals node metastasis unintentionally resected. The present study aimed to evaluate the prognosis of these patients. Methods: A retrospective cohort of patients submitted to thyroidectomy with or without central compartment neck dissection (CCND) due to PTC with a minimum follow-up of five years. Results: A total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37 pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node metastasis were younger, had larger tumors, higher rates of microscopic extra-thyroidal extension, and angiolymphatic invasion and most received radioiodine therapy. Treatment failure was higher in patients pN1a-incidental and pN1a-CCND (32% and 16%, respectively; p textless 0.001—Chi-square test). Disease-free survival (DFS) was lower in patients pN1a-incidental compared to patients Nx and pN0-incidental (p textless 0.001 vs. Nx and pN0-incidental and p = 0.005 vs. pN0-CCND) but similar when compared to patients pN1a-CCND (p = 0.091)—Log-Rank test. Multivariate analysis demonstrated as independent risk factors: pT4a (HR = 5.524; 95%CI: 1.380–22.113; p = 0.016), pN1a-incidental (HR = 3.691; 95%CI: 1.556–8.755; p = 0.003), microscopic extra-thyroidal extension (HR = 2.560; 95%CI: 1.303–5.030; p = 0.006) and angiolymphatic invasion (HR = 2.240; 95%CI: 1.077–4.510; p = 0.030). Conclusion: Patients that were pN1a-incidental were independently associated with lower DFS.
Citação
@online{renan_aguera2023,
author = {Renan Aguera , Pinheiro and Ana Kober , Leite and Beatriz
Godoi , Cavalheiro and Mello, Evandro Sobroza, De and Luiz Paulo ,
Kowalski and Leandro Luongo , Matos},
title = {Incidental Node Metastasis as an Independent Factor of Worse
Disease-Free Survival in Patients with Papillary Thyroid Carcinoma},
volume = {15},
number = {3},
date = {2023-02-02},
doi = {10.3390/cancers15030943},
langid = {pt-BR},
abstract = {Introduction: Papillary thyroid carcinoma (PTC) have high
node metastasis rates. Occasionally after thyroidectomy, the
pathological report reveals node metastasis unintentionally
resected. The present study aimed to evaluate the prognosis of these
patients. Methods: A retrospective cohort of patients submitted to
thyroidectomy with or without central compartment neck dissection
(CCND) due to PTC with a minimum follow-up of five years. Results: A
total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37
pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node
metastasis were younger, had larger tumors, higher rates of
microscopic extra-thyroidal extension, and angiolymphatic invasion
and most received radioiodine therapy. Treatment failure was higher
in patients pN1a-incidental and pN1a-CCND (32\% and 16\%,
respectively; p textless 0.001—Chi-square test). Disease-free
survival (DFS) was lower in patients pN1a-incidental compared to
patients Nx and pN0-incidental (p textless 0.001 vs. Nx and
pN0-incidental and p = 0.005 vs. pN0-CCND) but similar when compared
to patients pN1a-CCND (p = 0.091)—Log-Rank test. Multivariate
analysis demonstrated as independent risk factors: pT4a (HR = 5.524;
95\%CI: 1.380–22.113; p = 0.016), pN1a-incidental (HR = 3.691;
95\%CI: 1.556–8.755; p = 0.003), microscopic extra-thyroidal
extension (HR = 2.560; 95\%CI: 1.303–5.030; p = 0.006) and
angiolymphatic invasion (HR = 2.240; 95\%CI: 1.077–4.510; p =
0.030). Conclusion: Patients that were pN1a-incidental were
independently associated with lower DFS.}
}