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Original article
DOI: 10.1016/j.cireng.2020.03.012
Risk Factors of Metastatic Lymph Nodes in Papillary Thyroid Microcarcinoma
Factores de riesgo de metástasis ganglionares en el microcarcinoma papilar de tiroides
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José Ruiz Pardoa,,
Corresponding author
josrp@hotmail.es

Corresponding author.
, Antonio Ríosa,b,c,, José M. Rodrígueza,b,c, Miriam Paredesa, Víctor Sorianoa, María I. Oviedod, Antonio M. Hernándeze, Pascual Parrillaa,b,c
a Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
b Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
c Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, Spain
d Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
e Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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Figures (2)
Tables (3)
Table 1. Comparison of Demographic and Clinical Variables According to the Presence or Absence of Metastatic Lymph Nodes (Central and Lateral) of the PTMC.
Table 2. Comparison of Histopathological Variables According to the Presence or not of Metastatic Lymphadenopathies (Central and Lateral) of the PTMC.
Table 3. Multivariate Analysis of Factors Associated With the Presence of Lymph Node Metastases (Central and Lateral) of the PTMC.
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Abstract
Introduction

Papillary thyroid microcarcinoma (PTMC) usually has an indolent course, but some have worse prognostic factors, such as the presence of central (6.9%–51.5%) and lateral (3%–49.6%) lymph node metastases. The aim of this study is to analyze the factors associated with PTMC with metastatic lymph nodes and its long-term prognosis.

Methods

Retrospective study whose study population consists of patients with PTMC (size ≤1cm). Patients with previous thyroid surgery, other synchronous malignancies and ectopic location of the PTMC were excluded. Two groups were compared: PTMC without metastatic lymph nodes (group 1) and PTMC with metastatic lymph nodes (group 2). A multivariate analysis using a logistic regression model and a Kaplan–Meier survival analysis with log-rank test were performed.

Results

Out of the 161 selected patients, 9.3% (n=15) had metastatic lymph nodes. Multifocality (OR 5.284, 95%CI 1.056–26.443; P=.043) and extrathyroidal extension (OR 7.687, 95%CI 1.405–42.050; P=.019) were associated with the presence of metastatic lymph nodes. In PTMC with metastatic lymph nodes, more aggressive treatments were performed: lymphadenectomy (4.8% vs. 100%; P<.001) and radioactive iodine (24.7% vs. 100%; P<.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 6.7%; P=.093). No patients died due to the disease.

Conclusions

Multifocality and extrathyroidal extension of PTMC were associated with the presence of metastatic lymph nodes. Metastatic PTMC, with more aggressive treatments, presents an excellent long-term prognosis.

Keywords:
Thyroid cancer
Papillary thyroid cancer
Papillary thyroid microcarcinoma
Metastatic lymph nodes
Prognosis
Resumen
Introducción

El microcarcinoma papilar de tiroides (MCPT) suele tener un curso indolente, pero algunos presentan factores de peor pronóstico, como la presencia de adenopatías metastásicas centrales (6,9-51,5%) y laterales (3-49,6%). El objetivo de este estudio es analizar los factores asociados al MCPT con adenopatías metastásicas y su pronóstico a largo plazo.

Métodos

Estudio retrospectivo cuya población a estudio la constituyen los pacientes con MCPT (tamaño ≤1cm). Se excluyen los pacientes con cirugía tiroidea previa, otras patologías malignas sincrónicas, y localización ectópica del MCPT. Se comparan dos grupos: MCPT sin adenopatías metastásicas (grupo 1) y MCPT con adenopatías metastásicas (grupo 2). Se realizan un análisis multivariante mediante una regresión logística y un análisis de la supervivencia mediante el método de Kaplan-Meier y el test log-rank.

Resultados

De los 161 pacientes seleccionados, el 9,3% (n=15) tuvo adenopatías metastásicas. La multifocalidad (OR 5,284, IC 95% 1,056-26,443; p=0,043) y la invasión extracapsular (OR 7,687, IC 95% 1,405-42,050; p=0,019) se asociaron con la presencia de adenopatías metastásicas. En el MCPT con adenopatías metastásicas, se realizaron tratamientos más agresivos: linfadenectomía cervical (4,8% vs. 100%; p<0,001) y radioyodo (24,7% vs. 100%; p<0,001). Durante un seguimiento medio de 119,8±65 meses se detectó una recidiva en el grupo 2 (0% vs. 6,7%; p=0,093). Ningún paciente falleció debido a la enfermedad.

Conclusiones

La multifocalidad y la invasión extracapsular del MCPT se asocian con la presencia de adenopatías metastásicas. El MCPT metastásico, con tratamientos más agresivos, presenta un excelente pronóstico a largo plazo.

Palabras clave:
Cáncer de tiroides
Cáncer papilar de tiroides
Microcarcinoma papilar de tiroides
Adenopatías metastásicas
Pronóstico

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