Metastatic lymph node characteristics as predictors of recurrence/persistence in the neck and distant metastases in differentiated thyroid cancer

Barbosa, Mayara Peres; Momesso, Denise; Bulzico, Daniel Alves; Farias, Terence; Dias, Fernando; Lima, Roberto Araújo; Corbo, Rossana; Vaisman, Mario; Vaisman, Fernanda

doi:10.1590/2359-3997000000307

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Archives of Endocrinology and Metabolism

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Original Article • Arch. Endocrinol. Metab. 61 (6) • Dec 2017 • https://doi.org/10.1590/2359-3997000000307 copy

Metastatic lymph node characteristics as predictors of recurrence/persistence in the neck and distant metastases in differentiated thyroid cancer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The aim of this study was to evaluate the association between this characteristic and outcomes in patients with lymph node metastasis in a Brazilian cohort.

Subjects and methods:

This study examined a retrospective cohort of adult patients diagnosed with differentiated thyroid cancer and lymph node metastases from 1998 to 2015 in two referral centers. Number, location, size and extranodal extension (ENE) of metastatic lymph nodes were assessed and correlated with response to initial therapy.

Results:

A greater number of metastatic nodes, larger size, presence of lateral neck disease and ENE were all associated with a lower probability of achieving an excellent response to initial therapy (p ≤ 0.05 for all these parameters). Local recurrent disease had a significant association with lymph node number (6 in the recurrence/persistence group versus 4 in the non-recurrent group; p = 0.02) and ENE (19.2 versus 75%, p = 0.03). Lateral neck disease was the only characteristic associated with distant metastasis and was present in 52.1% of the group without metastasis and 70.4% of the group with metastasis (p = 0.001).

Conclusion:

The lymph node characteristics were associated with response to initial therapy and neck recurrence/persistence, confirming the importance of the analysis of these factors in risk stratification in a Brazilian population and its possible use to tailor initial staging and long term follow-up.

Keywords
Neck recurrence/persistence; thyroid cancer; lymph nodes; prognosis

Characteristic		N = 211	%
Gender (F:M)		150:61	71.1:28.9
Age at diagnosis (years)		41 (21-77)	-
Size (cm)		2.2 (0.3-15)	-
Race
	White	146	69.2
	Black	10	4.7
	Latin	51	24.2
	Not informed	4	1.9
Size (cm)		2.2 (0.3-15)	-
Total thyroidectomy		211	100
Histology
	PTC	192	90.9
	Invasive follicular variant of PTC	13	6.2
	Hurthle variant	3	1.4
	FTC	3	1.4
ETE		121	57.3
Multifocality		103	48.8
Vascular invasion		63	29.9
cN1		131	62.1
Lymph node staging
	> 5 metastatic lymph nodes	99	46.9
	> 3 cm metastatic lymph node	40	19
	Central compartment only (N1A)	91	43.1
	Lateral compartment (N1B)	102	48.3
	Extra nodal extension	15	7.1
Distant metastasis		27	12.8
RAI		211	100
Initial activity (mCi)		150 (30-250)	-
Total activity (mCi)		200 (100-1100)	-
ATA 2015 risk
	Low	21	9.9
	Intermediate	110	52.1
	High	80	38
Follow-up (years)		6.2 (0.8-17)	-
Final status
	NED with additional therapy	89	42.2
	Biochemical persistent disease	74	35.1
	Structural persistent disease	43	20.4
Deaths		5	2.4

Characteristic	Excellent response (n = 67)	Indeterminate response (n = 16)	Biochemical incomplete (n = 84)	Structural incomplete (n = 44)	p-value
> 5 metastatic lymph nodes	33.3%	37.5%	71.5%	70%	0.05
> 3 cm metastatic lymph nodes	16.7%	25%	26.6%	26.7%	0.01
Lymph node	49.3%	50%	47.6%	20.5%	0.02
Central compartment alone (N1A)
Lateral compartment (N1B)	48.7%	50%	52.4%	79.5%	0.02
Extranodal extension	6.7%	6.25%	8.2%	14.3%	0.03

N = 211		LN Recurrence/persistence (n = 52)	No LN recurrence/persistence (n = 159)	p-value
Age		38 (21-77)	42 (21-72)	0.08
Gender (F:M)		67.3%:32.7%	71.7%:28.3%	0.3 (NS)
cN1		66.7%	75.3%	0.4 (NS)
Number of metastatic lymph nodes		6 (2-33)	4 (1-30)	0.02
> 3 cm metastatic lymph node		30.5%	26%	0.08
Lymph node		28.5%	41.6%	0.07
Central compartment (N1A)
Lateral compartment (N1B)		71.5%	58.4%	0.07
Extranodal extension		19.2%	7.5%	0.03
Histology				0.4
PTC		90.6%	86.4%
	FV PTC	7.5%	9.3%
	Hurthle variant	0	2.9%
	FTC	1.9%	1.4%
Tumor size (cm)		2.5 (1.0-8.0)	2.0 (0.3-15)	0.3 (NS)
ETE		65.3%	55.8%	0.3 (NS)
Multifocality		53.1%	51.1%	0.8 (NS)
Vascular invasion		34%	20.4%	0.05
Distant metastases		13.5%	12.6%	0.5 (NS)
RAI initial activity (mCi)		150 (100-200)	150 (30-250)	0.5 (NS)
RAI cumulative activity(mCi)		350 (120-1050)	150 (100-1100)	< 0.001
Post-operative suppressed Thyroglobulin (ng/mL)		92 (< 0.1-460)	1.15 (< 0.1-280)	0.01

	Distant metastasis (n = 27)	No distant metastasis (n = 184)	RR (IC 95%)	p-value
Clinical N1	87.5%	71.4%	1.19 (0.99-1.5)	0.06
Vascular invasion by the primary tumor	50%	28.2%	1.83 (1.19-2.82)	0.04
> 3 cm metastatic lymph nodes	22%	19.5%	1.13 (0.52-2.4)	0.7
Extra nodal extension	12%	9.1%	1.2 (0.39-4.07)	0.7
> 5 metastatic lymph nodes	59%	44.5%	1.3 (0.93-1.8)	0.1
N1b	70.4%	52.1%	1.3 (1.01-1.78)	0.03

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[1] Correspondence to: Mayara Peres Barbosa, Rua Augusto Spinelli, 178/105, 28610-190 - Nova Friburgo, RJ, Brasil. mayperes5@yahoo.com.br