Predictive factors and prognosis for recurrent laryngeal nerve invasion in papillary thyroid carcinoma
Received 29 May 2017
Accepted for publication 18 July 2017
Published 11 September 2017 Volume 2017:10 Pages 4485—4491
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Akshita Wason
Peer reviewer comments 2
Editor who approved publication: Dr Tohru Yamada
Wenjie Chen,1 Jianyong Lei,1 Jiaying You,2 Yali Lei,3 Zhihui Li,1 Rixiang Gong,1 Huairong Tang,3 Jingqiang Zhu1
1Thyroid and Parathyroid Surgery Center, 2West China School of Clinical Medicine, 3Health and Management Center, West China Hospital of Sichuan University, Chengdu, People’s Republic of China
Background: Recurrent laryngeal nerve (RLN) invasion in papillary thyroid carcinoma (PTC) is one of the main predictors of poor prognosis. The present study investigated the risk factors for RLN invasion in PTC patients.
Methods: A total of 3,236 patients who received thyroidectomy due to PTC in Thyroid and Parathyroid Surgery Center of West China Hospital of Sichuan University were reviewed. Demographics and clinical factors, imaging examination (ultrasonography) characteristics, surgical details, postoperative pathological details, recurrence, and postoperative complications were recorded. Univariate and multivariate analyses were used to study the risk factors of RLN invasion, Kaplan–Meier method was performed to compare the outcomes of tumor recurrence.
Results: Patients with RLN invasion had a higher recurrence rate than those in the control group (p<0.001). Multivariate analyses showed that age greater than 45 years (p<0.001), a largest tumor size bigger than 10 mm (p<0.001), clinical lymph node metastasis (cN1) (p<0.001), posterior focus (p<0.001), extrathyroidal extension (p<0.001), esophageal extension (p<0.001), tracheal extension (p<0.001), and preoperative vocal cord paralysis (p<0.001) were independent predictors for RLN invasion.
Conclusion: PTC patients with RLN invasion have a negative prognosis and a higher recurrence rate. Meticulous operation and careful follow-up of patients with the above factors is recommended.
Keywords: papillary thyroid carcinoma, recurrent laryngeal nerve invasion, predictive factors, lymph node metastases, Hashimoto’s thyroiditis