Factors Related to Lymph Node Recurrence in Patients with N1b Papillary Thyroid Carcinoma after Unilateral Therapeutic Modified Radical Neck Dissection: A Meta-analysis

Abstract

Background Papillary thyroid carcinoma with clinically node-positive lateral neck (N1b PTC) is likely to recur after modified radical neck dissection (MRND). The present study investigated the risk factors for recurrence in N1b PTC patients after unilateral therapeutic MRND.

Methods Literature published from January 1990 to December 2017 on factors related to lymph node recurrence after MRND was retrieved by searching national and international online databases. A meta-analysis was performed after the data extraction process.

Results Thirty-five potentially relevant articles were found on lymph node recurrence in patients with N1b papillary thyroid carcinoma. After careful review of the full text of these articles, seven studies were included. There was no association between recurrence and the age of the patients (OR = 1.28, 95% CI = 0.77 – 2.12, p = 0.34). Male patients (OR = 1.63, 95% CI = 1.17 – 2.27, p = 0.004), tumor size ≥ 1 cm (OR = 0.14, 95% CI = 0.03 – 0.76, p = 0.02), multifocal tumors (OR = 1.55; 95% CI = 1.08 – 2.22, p = 0.02), extracapsular invasion (OR = 1.92, 95% CI = 1.26 – 2.95, p = 0.003), and lymphovascular invasion (OR = 2.52, 95% CI = 1.50 – 4.22, p = 0.0005) were associated with a significantly higher incidence of recurrence.

Conclusions Patients with a tumor size ≥ 1 cm, multifocality, extrathyroidal extension, or lymphovascular invasion were more likely to have tumor recurrence after total thyroidectomy and therapeutic MRND.

Zusammenfassung

Hintergrund Bei papillären Schilddrüsenkarzinomen mit klinischem Lymphknotennachweis im lateralen Halskompartiment (N1b PTC) ist nach modifiziert-radikaler Neck Dissection (MRND) mit Rezidiven zu rechnen. In der vorliegenden Studie wurden die Risikofaktoren für ein Rezidiv bei Patienten mit N1b PTC nach unilateraler therapeutischer MRND untersucht.

Methoden Es erfolgte eine Recherche der zwischen Januar 1990 und Dezember 2017 veröffentlichten Literatur zu Faktoren in Zusammenhang mit Lymphknotenrezidiven nach MRND in nationalen und internationalen Online-Datenbanken. Nach dem Datenextraktionsprozess wurde eine Metaanalyse durchgeführt.

Ergebnisse Die Suche ergab fünfunddreißig potenziell relevante Artikel über Lymphknotenrezidive bei Patienten mit papillärem Schilddrüsenkarzinom mit Lymphknotenstatus N1b. Nach sorgfältiger Durchsicht des vollständigen Textes dieser Artikel wurden sieben Studien in die Analyse einbezogen. Es fand sich kein Zusammenhang zwischen Rezidiven und dem Alter der Patienten (OR = 1,28; 95%-KI = 0,77 – 2,12; p = 0,34). Männliche Patienten (OR = 1,63; 95%-KI = 1,17 – 2,27; p = 0,004), Tumorgröße ≥ 1 cm (OR = 0,14; 95%-KI = 0,03 – 0,76; p = 0,02), multifokale Tumoren (OR = 1,55; 95%-KI = 1,08 – 2,22; p = 0,02), extrakapsuläre Invasion (OR = 1,92; 95%-KI = 1,26 – 2,95; p = 0,003) und lymphovaskuläre Invasion (OR = 2,52; 95%-KI = 1,50 – 4,22; p = 0,0005) waren mit einer signifikant höheren Inzidenz von Rezidiven assoziiert.

Schlussfolgerungen Bei Patienten mit Tumorgröße ≥ 1 cm, Multifokalität, extrathyreoidaler Tumorausbreitung oder lymphovaskulärer Invasion war die Wahrscheinlichkeit eines Tumorrezidivs nach totaler Thyreoidektomie und therapeutischer MRND erhöht.

Key words

cancer - surgical research - risk factor

Schlüsselwörter

Krebs - chirurgische Forschung - Risikofaktor

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