Med Bull Sisli Etfal Hosp. 2023; 57(3): 312-319 | DOI: 10.14744/SEMB.2023.90235

Predictive Factors Affecting the Development of Lateral Lymph Node Metastasis in Papillary Thyroid Cancer

Ozan Caliskan¹, Mehmet Taner Unlu¹, Ceylan Yanar², Mehmet Kostek¹, Nurcihan Aygun¹, Mehmet Uludag^2
1Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
²Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye

Objectives: Lateral lymph node metastasis (LLNM) in papillary thyroid cancer (PTC) determines the extent of surgery to be per- formed and the prognosis of the disease. In this study, we aimed to evaluate the clinicopathological risk factors affecting the development of LLNM.
Methods: We retrospectively evaluated the demographic and clinicopathological data of 346 cases with PTC who were operated in our clinic between May 2012 and September 2020. The patients were divided into 2 groups as patients with LLNM (Group 1) and without LLNM (Group 2).
Results: Thirty-six (10.4%) patients out of 346 patients with PTC had LLNM. A statistically significant difference was found between Group 1 and Group 2 regarding the male gender (M/F: 38.9% vs. 21.6%; p=0.020), tumor size (2.30±1.99 cm vs. 1.31±1.40 cm; p=0.000), lymphovascular invasion (69.4 vs. 20.6%; p=0.000), multicentricity (69.4% vs. 35.5%; p=0.000), multifocality (p=0.000), aggressive variant (22.2% vs. 9.4%; p=0.000), extrathyroidal extension (50% vs. 16.1% p=0.000), central lymph node metastasis (CLNM) rates (75% vs. 6.5%; p=0.000), and ≥3 cm lymph node metastasis (48.5% vs. 0%, p=0.000), distant metastasis (2.1% vs. 0%, p=0.000), respectively. Multivariance analysis determined the presence of CLNM as an independent risk factor for the development of LLNM.
Conclusion: The presence of CLNM in patients with PTC was determined as an independent risk factor for the development of LLNM. Although there has been increasing debate about prophylactic central neck dissection (pCND) in LLNM, pCND should still be considered in these patients as the rate of CLNM is high in patients with LLNM. CLNM might be a reference for surgeons to de- termine the extent of surgery. In addition, the presence of CLNM is important for close follow-up for the early detection of LLNM recurrence.

Keywords: Central lymph node metastasis, lateral lymph node metastasis, papillary thyroid cancer, risk factors

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Papiller Tiroid Kanserinde Lateral Lenf Nodu Metastaz Geliþimini Etkileyen Öngörü Faktörleri

Ozan Caliskan¹, Mehmet Taner Unlu¹, Ceylan Yanar², Mehmet Kostek¹, Nurcihan Aygun¹, Mehmet Uludag^2
1Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Türkiye Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul

Amaç: Papiller tiroid kanserinde (PTK) lateral lenf nodu metastazý (LLNM), uygulanacak cerrahinin geniþliðini ve hastalýðýn prognozunu belirlemektedir. Biz bu çalýþmada LLNM geliþimi üzerine etkili klinikopatolojik risk faktörlerini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kliniðimizde, Mayýs 2012-Eylül 2020 tarihleri arasýnda opere edilen PTK tanýlý 346 vakaya ait demografik ve klinikopatolojik verileri, univaryans ve multivaryans analiz aracýlýðýyla retrospektif olarak deðerlendirdik. Hastalar, LLNM olan (Grup 1) ve olmayan (Grup 2) olarak 2 gruba ayýrýldý.
Bulgular: 346 PTK’lý hastanýn 36’sýnda (%10.4) LLNM bulunmaktaydý. Grup 1 ile Grup 2 arasýnda; sýrasýyla erkek hasta (E/K: %38.9 vs %21.6; p=0.020), tümör boyutu (2.30 ± 1.99 cm vs 1.31 ± 1.40 cm; p=0.000), lenfovasküler invazyon (%69.4vs %20.6; p=0.000), multisentrisite (%69.4 vs %35.5; p=0.000), multifokalite ( p=0.000), agresif varyant (tall cell, hobnail, solid, diffüz sklerozan alt tipleri) (%22.2 vs %9.4; p=0.000), ekstratiroidal yayýlým (ETE) (%50 vs %16.1 p=0.000), santral lenf nodu metastaz(SLNM) oranlarý (%75 vs %6.5; p=0.000), ve >=3cm lenf nodu metastazý olmasý (%48.5 vs % 0, p=0.000),uzak metastaz olmasý(%2,1 vs % 0, p=0.000 ) açýsýndan istatistiksel olarak anlamlý farklýlýk saptandý. Multivaryans analiz ise SLNM varlýðýný, LLNM geliþimi için baðýmsýz risk faktörü olarak gösterdi.
Sonuç: PTK’lý hastalarda SLNM varlýðý, LLNM geliþimi için baðýmsýz risk faktörü olarak tespit edildi. LLNM’da profilaktik santal boyun diseksiyonu(SBD) ile ilgili tartýþmalar artmasýna raðmen, LLNM olan hastalarda SLNM oraný yüksek olduðundan bu hastalarda profilaktik SBD halen göz önünde bulundurulmalýdýr. SLNM cerrahinin geniþliðini belirleyebilmek açýsýndan cerrahlara referans saðlayabilir.Ayrýca SLNM’ýn varlýðý LLNM nüksünün erken tespiti açýsýndan yakýn takip önemlidir. (SETB-2023-08-157)

Anahtar Kelimeler: Santral lenf nodu metastazý, lateral lenf nodu metastazý, papiller tiroid kanseri, risk faktörleri

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