Synergy of nodal factors in predicting recurrence after treatment of N1b papillary thyroid carcinoma

Keyao Xian; Siyuan Xu; Hui Huang; Chengwei Xing; Xiaolei Wang; Shaoyan Liu; Jie Liu

doi:10.1210/clinem/dgae329

Synergy of nodal factors in predicting recurrence after treatment of N1b papillary thyroid carcinoma

J Clin Endocrinol Metab. 2024 May 15:dgae329. doi: 10.1210/clinem/dgae329. Online ahead of print.

Authors

Keyao Xian¹, Siyuan Xu², Hui Huang¹, Chengwei Xing¹, Xiaolei Wang¹, Shaoyan Liu¹, Jie Liu¹

Affiliations

¹ Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
² Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.

PMID: 38748619
DOI: 10.1210/clinem/dgae329

Abstract

Background: Nodal factors are important predictors of prognosis for papillary thyroid carcinoma (PTC), but their synergy effect is not well understood. We aimed to explore their synergy effect in predicting recurrence of clinical N1b PTC.

Methods: Patients who underwent surgery for cN1b PTC from 2013 to 2017 were enrolled. The association between nodal factors and recurrence was assessed using Cox proportional hazards regression models. Interaction and stratified analyses were conducted according to significant nodal factors.

Results: Of 1067 cN1b PTC patients included, all nodal factors (bilateral metastasis, largest dimension>3cm, micro and gross extranodal extension (mENE, gENE), No. of metastatic lymph nodes (MLN), lymph node yield (LNY) and ratio (LNR)) were significantly associated with all site and nodal recurrence in the univariate analysis (all P<0.05). Multivariate analyses revealed largest dimension>3cm, gENE and LNR>0.21 were associated with elevated both all site (HR [95%CI], 2.58 [1.67-4.00], 1.87[1.26-3.01], 1.68[1.11-2.42], all P<0.01) and nodal recurrences (HR[95%CI], 2.63[1.67-4.13], 1.90[1.15-3.12], 1.76[1.17-2.66], all P<0.01). LNR and gENE had interactive effect (all site recurrence: P for interaction = 0.009; nodal recurrence: P for interaction = 0.02). LNR was significantly associated with recurrence in patients without gENE (HR[95% CI], all site recurrence: 2.41[1.50-3.87]; nodal recurrence: 2.51[1.52-4.14], all P< 0.001), while when gENE appeared, LNR was no longer associated with recurrence (HR [95% CI], all site recurrence: 0.81[0.43-1.54], P=0.53; nodal recurrence: 0.85[0.43-1.67], P=0.64).

Conclusions: Nodal factors have synergy effect in predicting recurrence in cN1b PTC patients. Increasing lymph nodes harvest may only decrease recurrence in patients without gENE, while not in gENE patients.

Keywords: Papillary thyroid carcinoma; nodal factors; recurrence-free survival; synergy effect.

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