Analysis of Risk Factors for Lymph Node Metastases in Elderly Patients with Papillary Thyroid Micro-Carcinoma
Authors Fu GM, Wang ZH, Chen YB, Li CH, Zhang YJ, Li XJ, Wan QX
Received 4 February 2020
Accepted for publication 18 July 2020
Published 11 August 2020 Volume 2020:12 Pages 7143—7149
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Eileen O'Reilly
Gui-Ming Fu,1 Zhao-Hui Wang,1 Yi-Bo Chen,1 Chun-Hua Li,1 Yue-Jia Zhang,1,2 Xiao-Jing Li,1,2 Quan-Xin Wan1,2
1Head and Neck Surgery Center, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People’s Republic of China; 2Department of Oncology, Chengdu Second People’s Hospital, Chengdu 610041, People’s Republic of China
Correspondence: Zhao-Hui Wang Email firstname.lastname@example.org
Background: With guidance from the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th edition, we explored the characteristics of central lymph node metastasis (CLNM) of papillary thyroid micro-carcinoma (PTMC) in elderly patients ≥ 55 years of age. Our goal was to provide references for establishing a lymph node dissection scheme in such patients.
Methods: We retrospectively analyzed the clinical data of thyroid cancer patients admitted to the Head and Neck Surgery Center of Sichuan Cancer Hospital, Chengdu, China, from January 2015 to September 2018. Then, we screened and analyzed eligible PTMC cases in strict accordance with our inclusion and exclusion criteria.
Results: The study included 107 patients, including 24 men and 83 women. Median age was 59.99 ± 4.58 years. The maximum diameter range of the cancer foci was 4– 10 mm, and the median was 7.59 ± 1.78 mm. Unilateral lobectomy had been performed in 32 cases, total thyroidectomy in 75 cases and lateral cervical lymph node dissection in 21 cases. There were 60 cases of CLNM (56.07%) and 13 cases of lateral cervical lymph node metastasis (12.10%). The sensitivity of preoperative ultrasound in predicting CLNM was 100%, but its accuracy was only 50.47%. Multivariate logistic regression analysis showed that multiple cancer foci (area under the curve [AUC] = 0.632), extra-thyroidal expansion of cancer focus (AUC = 0.721), and irregular nodules (AUC = 0.603) were independent risk factors for CLNM of PTMC in elderly patients (P < 0.05). Overall predictability for PTMC-CLNM was 80.30%.
Conclusion: 1) Preoperative color Doppler ultrasound is not recommended as the basis for cervical lymph node dissection in PTMC patients. 2) For multiple cancer foci, irregular nodules, and elderly patients with PTMC extra-thyroidal expansion, we recommend a prophylactic central lymph node dissecting. 3) Nonsurgical observation of PTMC in elderly patients with low risk should be carefully selected.
Keywords: elderly patients, thyroid cancer, papillary carcinoma, micro-carcinoma, central lymph node metastasis
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]