Vas Nunes, Jonathan H. (2012) Prognostic Implications of Lymph Node Yield and Lymph Node Ratio in Papillary Thyroid Carcinoma. thesis, Medicine.
Full text available on request.Abstract
Background: The lymph node yield (LNY: total number of lymph nodes dissected) and the lymph node ratio (LNR: number of positive lymph nodes dissected divided by the total number of lymph nodes dissected) have been shown to be important prognostic factors in oral, colon and gastric cancers. The role of the LNY and LNR in papillary thyroid cancer (PTC) is unclear. The aims of this study is to determine if a high LNR and a low LNY decrease disease-free survival rates. This study further aimed to determine an optimum nodal yield. Methods. A retrospective analysis was conducted of 198 patients with PTC undergoing total thyroidectomy with neck dissection between 1987 and 2011. The LNY and LNR were adjusted by relevant covariates in a multivariable Cox regression analysis with Andersen-Gill extension. Results: The LNR is associated with a decrease in disease-free survival (HR, 3.2; CI, 1.4-7.3; p = .005). Patients with a LNR of 0.30 or higher have a 3.4 times higher risk of persistent or recurrent disease when compared to patients with a LNR of 0.00 (CI, 1.1-10.5; p = .031). Conversely, patients with a LNR of 0.11 or lower had an 80% chance of remaining disease free during 5 years of follow-up. The LNY showed no significant independent effect and an optimum nodal yield was not determined. Conclusions: The LNR is an independent prognostic factor in PTC and can be used in conjunction with existing clinicopathological classification and staging systems. A clinical relevant cut-off point of 1 positive lymph node out of 3 total is proposed. No prognostic implications of LNY have been found.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Karthaus Dr. A.J.M.(Deventer Hospital) and General and Trauma Surgeon and Affiliate coordinator (University of Groningen |
| Supervisor name: | Elliott Dr. M.S. (Royal Prince Alfred Hospital) and Ear, Nose and Throat & Head and Neck Surgeon Clinical Senior and Missenden Road, Camperdown NSW 2050 and Sydney, Australia |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1508 |
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