Cervical lymph node metastasis and papillary thyroid carcinoma: Does the compartment involved affect survival? Experience from the SEER database

Abstract

Purpose Determine how the location of cervical lymph node metastases affects survival in papillary thyroid carcinoma (PTC) patients. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients diagnosed with PTC. Disease specific survival (DSS) was estimated according to node status and extent of cervical involvement by Kaplan–Meier analysis. Hazard ratios with 95% confidence intervals to estimate the risk of death were calculated using Cox multivariable regression analysis. Results We identified 11,453 PTC cases in the SEER database with complete data describing the absence or location of positive nodes. Of these, 40.1% were node-positive; 56.6%, 34.1%, and 9.3% of node-positive patients had metastasis to the central, lateral, and mediastinal compartments, respectively. DSS was worse for node-positive patients age ≥45 with lateral/mediastinal involvement relative to those with central metastasis (P < 0.001). Node metastasis did not significantly affect survival for patients age <45, regardless of location. Conclusions Patients age ≥45 with lateral/mediastinal cervical involvement have an increased risk of death from PTC in the initial years after diagnosis. Future studies are needed to elucidate optimal treatment and surveillance protocols for these patients, and also to ascertain the effect of cervical node location on long-term survival and disease-recurrence. J. Surg. Oncol. 2012; 106:357–362.