ABSTRACT
OBJECTIVE: To explore the risk factors of level V lymphatic metastasis in papillary thyroid carcinoma (PTC) patients with pN1b. METHODS: Patients were selected if they presented with a suspicious level III or IV lymph node metastasis and underwent surgery by hemi or total thyroidectomy with a lymph node dissection (levels III, IV, VI, and VII). For these patients, if frozen section showed a positive level III or IV node, then levels II and V nodes were resected. Univariate analysis was performed using the chi-square test for some factors, including age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, status of cervical lymphatic metastasis, TNM staging, tumor deposits (independent tumor nodules), and the metastasis to more than 5 central lymph nodes. Then, the factors with statistical significance indicated by the above univariate analysis underwent multivariate analysis. RESULTS: Univariate analysis indicated that the level V lymphatic metastasis was significantly associated with simultaneous metastases to levels II, III, and IV, simultaneous metastases to levels III and IV, and tumor deposits (all p < 0.05), but it was not significantly associated with age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, other cervical lymphatic metastasis, TNM staging, and the metastases to more than 5 central lymph nodes (all p > 0.05). Multivariate analysis suggested that the simultaneous metastases to levels III and IV and tumor deposits were the risk factors of level V lymphatic metastasis. CONCLUSION: The simultaneous metastases to levels III and IV and tumor deposits are independent risk factors of level V lymphatic metastasis. The patients with pN1b PTC who have simultaneous metastases to levels III and IV or/and tumor deposits may have the risk of level V lymph node metastasis.
ABSTRACT
OBJECTIVE: To investigate the clinico-pathologic characteristics, treatment and prognosis of thyroid carcinoma in childhood and adolescents. METHODS: From 1984 to 1997, 86 cases with thyroid carcinoma in childhood and adolescent treated were summarized. RESULTS: All cases underwent operation with adjuvant therapy. Pathologically, papillary carcinoma was diagnosed in 73 (84.9%), follicular carcinoma in 6 (7%), papillary-follicular carcinoma in 4 (4.7%) and medullary carcinoma in 3 (3.5%). Cervical lymph node metastasis was found in 59 cases (68.6%), 16 of which with both thyroid carcinoma and bilateral cervical lymph node metastasis (27.1%). Lung metastasis was found in 11 cases. Recurrence occurred in 6 cases after operation. Compared with the thyroid carcinoma in adult patients, cervical lymph node metastasis, bilateral involvement of the thyroid gland with bilateral cervical nodes and lung metastasis rate were more commonly seen in childhood and adolescence. All but 2 patients had been followed up for more than 5 years, 41 patients for more than 10 years. The 5-year and 10-year survival rate was 95.3% (82/86) and 87.8% (36/41), respectively. CONCLUSION: The clinical manifestations of childhood and adolescent thyroid cancer are generally not pathognostic which may lead to misdiagnosis. Surgery is the main method in the comprehensive treatment with a good prognosis. The therapy with (131)I after operation was beneficial for some patients accompanied with lung metastasis.
