Pathology, research and practice · 2025
Associations of clinicopathologic features and mutation status with lateral lymph node metastasis as a predictor of disease-free survival in papillary thyroid carcinoma.
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Nguyen Van Phu Thang, Kurohama Hirokazu, Akazawa Yuko, Nguyen Thi Ngoc Anh, Matsuda Katsuya, Matsuoka Yuki, Mussazhanova Zhanna, Yokota Kenichi, Satoh Shinya, Shindo Hisakazu, Nguyen Thi Nhung, Sailaubekova Yerkezhan, Kerimbayeva Adiya, Nakashima Masahiro
Аннотация
BACKGROUND: Lateral lymph node metastasis (LLNM) is a significant risk factor for poor prognosis in papillary thyroid carcinoma (PTC). Data on the association between LLNM and genetic alterations in PTC remains limited. This study investigated clinicopathological and molecular predictive factors for LLNM in patients with PTC.
METHODS: We conducted a single-center retrospective analysis of 603 patients who underwent thyroid surgery between January 2018 and December 2023. Clinicopathological features and genetic mutations, including BRAFV600E and telomerase reverse transcriptase (TERT) promoter mutations, were assessed to identify predictors of LLNM. The impact of these features on disease-free survival (DFS) was analyzed using multivariable Cox regression.
RESULTS: LLNM was found in 154 (25.5 %) patients. Independent predictors of LLNM included age < 55 years (odds ratio [OR] = 2.491, 95 % confidence interval [CI]: 1.411-4.398), multifocality (OR = 2.056, 95 % CI: 1.254-3.370), lymphatic invasion (OR = 1.811, 95 % CI: 1.094-2.997), gross extrathyroidal extension (ETE) (OR = 2.611, 95 % CI: 1.333-5.115), central lymph node metastasis (CLNM) without extranodal extension (ENE) (OR = 12.060, 95 % CI: 4.205-34.595) or with ENE (OR = 68.060, 95 % CI: 23.224-199.453), and TERT promoter mutation (OR = 2.272, 95 % CI: 1.078-4.786). CLNM with ENE, LLNM with ENE and TERT promoter mutation were significantly correlated with shorter DFS.
CONCLUSIONS: LLNM is not rare in PTC and represents an adverse prognostic factor significantly associated with age, gross ETE, multifocality, lymphatic invasion, CLNM, and TERT promoter mutation.
METHODS: We conducted a single-center retrospective analysis of 603 patients who underwent thyroid surgery between January 2018 and December 2023. Clinicopathological features and genetic mutations, including BRAFV600E and telomerase reverse transcriptase (TERT) promoter mutations, were assessed to identify predictors of LLNM. The impact of these features on disease-free survival (DFS) was analyzed using multivariable Cox regression.
RESULTS: LLNM was found in 154 (25.5 %) patients. Independent predictors of LLNM included age < 55 years (odds ratio [OR] = 2.491, 95 % confidence interval [CI]: 1.411-4.398), multifocality (OR = 2.056, 95 % CI: 1.254-3.370), lymphatic invasion (OR = 1.811, 95 % CI: 1.094-2.997), gross extrathyroidal extension (ETE) (OR = 2.611, 95 % CI: 1.333-5.115), central lymph node metastasis (CLNM) without extranodal extension (ENE) (OR = 12.060, 95 % CI: 4.205-34.595) or with ENE (OR = 68.060, 95 % CI: 23.224-199.453), and TERT promoter mutation (OR = 2.272, 95 % CI: 1.078-4.786). CLNM with ENE, LLNM with ENE and TERT promoter mutation were significantly correlated with shorter DFS.
CONCLUSIONS: LLNM is not rare in PTC and represents an adverse prognostic factor significantly associated with age, gross ETE, multifocality, lymphatic invasion, CLNM, and TERT promoter mutation.