ETA2024 Poster Presentations Clinical thyroid cancer research-1 (10 abstracts)
Impact of lymph node metastases features on presentation and outcome of patients with differentiated thyroid carcinoma (DTC)
Lea Contartese 1 , Carla Gambale 1 , Elisa Minaldi 1 , Liborio Torregrossa 2 , Eleonora Molinaro 1 , Laura Agate 1 , Gabriele Materazzi 3 , Rossella Elisei 1 & Antonio Matrone 1
1University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa, Italy; 2University Hospital of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Pahology Unit, Pisa, Italy; 3University Hospital of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, Pisa, Italy
Background: The impact of lymph node metastases (LNM) on the outcome of patients with DTC has been reevaluated in the last years. Its relevance is linked not only to the absence/presence of LNM, but also to other features such as number of LNM, dimension and extranodal extension (ENE).
Aim: The aim of this study was to evaluate in a large series of patients with DTC the impact of LNM on the clinical outcome. Patients were divided according to the risk of recurrence outlined by LNM features according to ATA 2015 Guidelines as follows: patients with LNM at low risk (LR-LNM: n ≤ 5 + < 0.2 cm), intermediate risk (IR-LNM: n > 5 + < 0.2 cm or any number LNM + 0.2-3 cm) and high risk (HR-LNM: any number LNM > 3 cm +/- ENE o ENE +).
Methods: We evaluated 1522 consecutive patients with DTC who underwent total thyroidectomy ± therapeutic central a/o laterocervical compartment lymph nodes dissection and radioiodine treatment (131I) between January 2010 and December 2012. LNM at histology were found in 291/1522 patients (19.1%). Of these, 65/291 (22.3%) patients were excluded because of the absence of complete histologic details about LNM. Overall, 23/226 (10.2%) were LR-LNM, 114/226 (50.4%) IR-LNM and 89/226 (39.4%) HR-LNM. Median follow-up time was 106 months (IQR 48–133).
Results: HR-LNM was more frequently associated with tumors > 4 cm (P = 0.01), mETE and N1b (P < 0.01), absence of histologic thyroiditis (P = 0.02) and more advanced stage at diagnosis (P = 0.025). Then, they were more frequently associated with distant metastases at whole body scan (P < 0.01). Moreover, during the follow-up HR-LNM patients performed more 131I courses and consequently higher 131I total activitiy. At the data lock (March 2024), structural disease was prevalent in HR-LNM (17/89 - 19.1%) than in IR-LNM (11/114 – 9.7%) and LR-LNM (2/23 - 8.7%) group.
Conclusion: HR-LNM, defined by dimension > 3 cm and the presence of ENE at histology, identifies a group of DTC patients with more aggressive disease and a higher risk of persistent/recurrent structural disease. Conversely, in presence of LR-LNM and IR-LNM the risk of persistent/recurrent structural disease is rather low and the need to perform radioiodine treatment in all cases is questionable.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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