Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis.
Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis.
- 2022
BACKGROUND: Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy. CONCLUSION: Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach. Copyright ♭ 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. RESULTS: Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors. STUDY DESIGN: Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution.
English
1072-7515
00019464-202204000-00034 [pii] 10.1097/XCS.0000000000000107 [doi]
*Thyroid Neoplasms
Female
Humans
Iodine Radioisotopes
Lymph Nodes/pa [Pathology]
Lymph Nodes/su [Surgery]
Lymphatic Metastasis/pa [Pathology]
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Factors
Thyroid Neoplasms/pa [Pathology]
Thyroid Neoplasms/su [Surgery]
MedStar Health Research Institute
MedStar Washington Hospital Center
Medicine/Endocrinology
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Endocrine Surgery
Journal Article
BACKGROUND: Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy. CONCLUSION: Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach. Copyright ♭ 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved. RESULTS: Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors. STUDY DESIGN: Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution.
English
1072-7515
00019464-202204000-00034 [pii] 10.1097/XCS.0000000000000107 [doi]
*Thyroid Neoplasms
Female
Humans
Iodine Radioisotopes
Lymph Nodes/pa [Pathology]
Lymph Nodes/su [Surgery]
Lymphatic Metastasis/pa [Pathology]
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Factors
Thyroid Neoplasms/pa [Pathology]
Thyroid Neoplasms/su [Surgery]
MedStar Health Research Institute
MedStar Washington Hospital Center
Medicine/Endocrinology
MedStar General Surgery Residency
MedStar Georgetown University Hospital/MedStar Washington Hospital Center
Surgery/Endocrine Surgery
Journal Article