5 years ago

Influence of coexistent Hashimoto's thyroiditis on the extent of cervical lymph node dissection and prognosis in papillary thyroid carcinoma

Min Ji Jeon, Young Kee Shong, Dong Eun Song, Eyun Song, Hye-Seon Oh, Mijin Kim, Tae Yong Kim, Won Gu Kim, Won Bae Kim, Suyeon Park
Objective Previous studies did not focus on the differences in the extent of cervical lymph node (LN) dissection according to coexistent Hashimoto's thyroiditis (HT) in patients with papillary thyroid carcinoma (PTC) and its clinical impact. We aimed to determine whether extensive cervical LN dissection is responsible for favorable clinical outcomes in PTC patients with HT and whether coexistence of HT itself has an independent protective effect regardless of LN status. Design Retrospective cohort study Patients 1,369 patients with PTC who underwent total thyroidectomy with central compartment neck dissection. Measurements Metastatic LN ratio, defined as number of metastatic LNs divided by number of removed LNs, was used to evaluate the extent of LN dissection as well as the status of LN metastasis. Disease-free survival and dynamic risk stratification were compared for clinical outcomes. Results Presence of HT did not lower the risk of cervical LN metastasis (61.6% in patients with HT vs. 65.1% in patients without HT, p=0.292). Patients with HT had significantly larger numbers of removed LNs than patients without HT (11 vs. 8, respectively, p<0.001). Accordingly, metastatic LN ratio was smaller in patients with HT (p=0.002) which was independently associated with structural persistent/recurrent disease (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.30-4.16, p=0.004). HT itself was negatively associated with structural persistent/recurrent disease after adjustment for other clinicopathological factors (HR 0.39, 95% CI 0.18–0.87, p=0.020). Conclusions Coexistence of HT itself is an independent factor associated with favorable outcome in PTC patients, regardless of extent of LN dissection. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/cen.13475

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