Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Background and Objectives: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis. Methods: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow-up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra-thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis. Results: Compared with the intra-thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease-specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow-up period of 16.90.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors. Conclusions: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra-thyroid tumor group. J. Surg. Oncol. 2015 111:149-154. (c) 2015 Wiley Periodicals, Inc.