Incidental papillary microcarcinoma of the thyroid--factors affecting lymph node metastasis.

BACKGROUND AND AIMS: Despite the overall excellent prognosis for patients with thyroid papillary microcarcinoma (PMC), these tumors are associated with lymph node metastasis. The aim of this study is to identify the rate of lymph node metastasis and evaluate the clinical and pathological factors affecting metastasis in thyroid PMC. METHODS: Among 475 patients with papillary thyroid carcinoma treated between 1990 and 2003, 81 patients (17%) were diagnosed as PMC and the records of these patients were evaluated retrospectively. Clinicopathologic features were evaluated by univariate and multivariate analyses. RESULTS: According to age, metastases, extent, and size risk definition, all patients were in low-risk group. Lymph node metastases were determined in 12.3% of patients. Mean follow-up was 7 years (range from 28 to 192 months). Ten-year disease-free and overall survival rates were 97 and 100%, respectively. Both multifocality and thyroid capsular invasion were found to be independent risk factors for lymph node metastasis by multivariate analysis. CONCLUSION: Patients with thyroid PMC in low-risk group with multifocal tumors and with capsule invasion may have increased risk of lymph node metastasis, and must be considered in follow-up of the patients who have these factors.

Prognostic impact of positive lymph node ratio in gastric carcinoma.

BACKGROUND AND OBJECTIVES: To evaluate the prognostic value of metastatic lymph node ratio in gastric carcinoma. METHODS: One hundred and sixty four patients who underwent D(2) dissection for gastric carcinoma at Ankara Oncology Hospital were reviewed retrospectively. The prognostic factors including Japanese classification, AJCC/UICC TNM classification and metastatic lymph node ratio (1-10% and >10%) were evaluated in univariate and multivariate Cox regression analysis. RESULTS: The multivariate analysis showed that Borrmann classification, pN-category of AJCC/UICC classification and metastatic lymph node ratio were the most significant prognostic factors and a higher hazard ratio was obtained for metastatic lymph node ratio than pN category of AJCC/UICC classification (4.5 vs. 11.4). When the metastatic ratio groups of 1-10% and >10% were subdivided into pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification, there was no statistical difference between survival curves. When pN(1), pN(2) and pN(3) categories of the AJCC/UICC classification were subdivided into the ratio groups of 1-10% and >10%, the survival rate of ratio group 1-10% was better than ratio group >10%. CONCLUSION: With its simplicity and reproducibility, metastatic lymph node ratio can be used as a reliable prognostic indicator.

Prediction of survival in gastric carcinoma related to lymph node grading by the new American Joint Committee on Cancer/Union International Contre le Cancer System or the Japanese system.

OBJECTIVE: To compare the classification of gastric cancer adopted by the American Joint Committee on Cancer and the Union International contre le Cancer (AJCC/UICC) (number of nodes involved) with the Japanese classification (sites of nodes involved). DESIGN: Retrospective study. SETTING: Teaching hospital, Turkey. SUBJECTS: 134 consecutive patients whose gastric cancer was treated by D2 resection. INTERVENTIONS: Kaplan-Meier survival analysis and Cox's regression model. MAIN OUTCOME MEASURE: Accuracy of prognosis. RESULTS: There were no significant differences in survival rates when pN1 and pN2 categories of the AJCC/UICC classification were subdivided into the n1 and n2 categories of the Japanese classification. However, when those in the n1 and n2 categories of the Japanese classification were subdivided into the pN1, pN2 and pN3 categories of the AJCC/UICC classification, survival differed significantly (p = 0.00001). When both classifications were combined in a multivariate analysis the pN category of the AJCC/UICC classification was found to be the most significant independent prognostic factor (p = 0.0001). CONCLUSION: Classification of lymph node status by number of nodes (AJCC/UICC) rather than anatomical site (Japanese) gives a more accurate prognosis.