Predictive Factors for Lateral Lymph Node Metastasis and Skip Metastasis in Papillary Thyroid Carcinoma
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Predictive Factors for Lateral Lymph Node Metastasis and Skip Metastasis in Papillary Thyroid Carcinoma Jia-Wei Feng 1 & An-Cheng Qin 2 & Jing Ye 1 & Hua Pan 1 & Yong Jiang 1 & Zhen Qu 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract In papillary thyroid cancer (PTC) patients, cervical lymph node metastases are common, which disseminate sequentially from the central neck to the lateral neck. However, there is also a chaotic pattern of lymph node metastasis occasionally. In this study, we summarized 653 PTC patients who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from two hospitals to investigate the pattern and risk factors of lateral lymph node metastasis (LLNM) and skip metastasis. LLNM was significantly associated tumor size > 1 cm, presence of extrathyroidal extension, tumors in the upper-lateral pole, and the number of metastatic lymph nodes in the central compartment. The frequency of skip metastasis was 22.5% (20 of 89 patients). Multivariate analyses showed tumor size ≤ 1 cm, and tumors in the upper-lateral pole were separately and independently associated with the risk of skip metastasis. Presence of LLNM affected the recurrence-free survival (RFS). RFS did not show the significantly difference between patients with LLNM and skip metastasis. Despite the low incidence of skip metastasis, attention should be paid to the possibility of LLNM even in the absence of central lymph node metastases. Besides, for patients with risk factors of LLNM or skip metastasis, detailed preoperative examination for the lateral compartment, especially the level III, is essential. Keywords Papillary thyroid carcinoma . Skip metastasis . Lateral lymph node metastasis . Recurrence-free survival
Introduction Papillary thyroid carcinoma (PTC), which accounts for approximately 80.0% of all thyroid malignancies, is rising at the fastest rate among all malignancies [1, 2]. Although PTC patients have an excellent prognosis, lymph node metastasis (LNM) is common, approximately up to 30 to 80% [3]. Many studies suggested that LNM, especially lateral lymph node metastasis (LLNM), could increase the risk of locoregional recurrence and decrease the survival [4, 5]. As previous studies reported, the dissemination of PTC cells through the lymphatic system usually occurred in a stepwise and continuous fashion. The first echelons * Yong Jiang [email protected] 1
The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
2
The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
of lymphatic drainage are in the tracheoesophageal groove, with subsequent drainage to the jugular chain. Occasionally, pretracheal (Delphian) nodes are involved. The lymph nodes in the ipsilateral lateral compartment may be involved subsequent to the involvement of the jugular chain [6, 7]. However, there is also a chaotic pattern of lymph node metastasis occasi
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