Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine
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ORIGINAL ARTICLE
Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine postthyroidectomy for low-risk papillary thyroid cancer Ewa Ruel1 • Samantha Thomas2,5 • Michaela A. Dinan3,5 • Jennifer M. Perkins1 Sanziana A. Roman4,5 • Julie Ann Sosa3,4,5
•
Received: 26 August 2015 / Accepted: 7 December 2015 Ó Springer Science+Business Media New York 2015
Abstract Cervical lymph node metastases are common in papillary thyroid cancer (PTC). Clinically negative lymph nodes confer uncertainty about true lymph node status, potentially prompting empiric postoperative radioactive iodine (RAI) administration even in low-risk patients. We examined the association of clinically (cN0) versus pathologically negative (pN0) lymph nodes with utilization of RAI for low-risk PTC. Using the National Cancer Database 1998–2011, adults with PTC who underwent total
& Sanziana A. Roman [email protected] Ewa Ruel [email protected] Samantha Thomas [email protected] Michaela A. Dinan [email protected] Jennifer M. Perkins [email protected] Julie Ann Sosa [email protected] 1
Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University Medical Center, DUMC 3924, 201 Trent Drive, Baker House 227, Durham, NC 27710, USA
2
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
3
Duke Clinical Research Institute, Duke University, 2400 Pratt St, Durham, NC 27705, USA
4
Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, DUMC #2945, Durham, NC 27710, USA
5
Duke Cancer Institute, Durham, NC, USA
thyroidectomy for Stage I/II tumors 1–4 cm were evaluated for receipt of RAI based on cN0 versus pN0 status. Cut-point analysis was conducted to determine the number of pN0 nodes associated with the greatest decrease in the odds of receipt of RAI. Survival models and multivariate analyses predicting RAI use were conducted separately for all patients and patients \45 years. 64,980 patients met study criteria; 39,778 (61.2 %) were cN0 versus 25,202 (38.8 %) pN0. Patients with pN0 nodes were more likely to have negative surgical margins and multifocal disease (all p \ 0.001). The mean negative nodes reported in surgical pathology specimens was 4; C5 pathologically negative lymph nodes provided the best cut-point associated with reduced RAI administration (OR 0.91, CI 0.85–0.97). After multivariable adjustment, pN0 patients with C5 nodes examined were less likely to receive RAI compared to cN0 patients across all ages (OR 0.89, p \ 0.001) and for patients aged \45 years (0R 0.86, p = 0.001). Patients with \5 pN0 nodes did not differ in RAI use compared to cN0 controls. Unadjusted survival was improved for pN0 versus cN0 patients across all ages (p \ 0.001), but not for patients\45 years (p = 0.11); adjusted survival for all ages did not differ (p = 0.13). Pathological confirmation of negative lymph nodes in patients with PTC appears to influence the decisio
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