Risk factors associated with preferential lateral lymph node metastasis in papillary thyroid carcinoma

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 22; pp. 20670 - 20676
• Main Authors: Shao, Liang, Wang, Zhihong, Dong, Wenwu, Sun, Wei, Zhang, Hao
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.11.2023; John Wiley and Sons Inc; Wiley
• Subjects: central lymph node; Goiter; Humans; lateral lymph node; Lymph nodes; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis - pathology; Lymphatic system; Medical prognosis; Metastases; Metastasis; Multivariate analysis; Neck Dissection; Papillary thyroid cancer; Papillary thyroid carcinoma; Pathology; Patients; Regression analysis; Retrospective Studies; risk factor; Risk Factors; Surgeons; Thoracic surgery; Thyroid cancer; Thyroid Cancer, Papillary - pathology; Thyroid Neoplasms - pathology; Thyroidectomy; Tumors; Ultrasonic imaging; central lymph node; lateral lymph node; metastasis; risk factor; papillary thyroid cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.6567

Background Lateral lymph node metastasis (LLNM) is common in patients with papillary thyroid cancer (PTC), usually occurring after central lymph node metastasis (CLNM). However, some patients experience LLNM without first developing CLNM. This study aimed to identify the risk factors for developing LLNM without CLNM. Methods We retrospectively reviewed 421 patients diagnosed with PTC who underwent lobectomy or total thyroidectomy with central and ipsilateral lateral lymph node dissection. We collected clinicopathological data and used univariate and multivariate logistic regression analyses to determine the risk factors associated with LLNM without CLNM. Results The LLNM without CLNM frequency was 18.3% (77/421). Univariate analyses demonstrated that age over 55 years, primary tumor in the upper portion of the thyroid, the number of central lymph node (CLN) and LLNM, primary tumor size, and the summed size of multi‐foci tumors smaller than 1 cm were significantly associated with LLNM without CLNM (p < 0.05). Multivariate analysis revealed that LLNM without CLNM was more likely to occur in patients aged ≥55 years (odds ratio [OR], 2.309; 95% confidence interval [CI], 1.133–4.704; p = 0.021), and primary tumor in the upper portion of the thyroid (OR, 0.524; 95% CI, 0.295–0.934; p = 0.028). Conclusion The lymph node metastasis pattern in patients with PTC is not constant. Therefore, surgeons should evaluate the lateral lymph nodes, especially in patients older than 55 years or when the primary tumor is in the upper portion of the thyroid.