Predictors of treatment response in lymphogenic metastasized papillary thyroid cancer: a histopathological study.

Abstract

BACKGROUND Lymph node metastases in papillary thyroid cancer (PTC) increase the risk for persistent and recurrent disease. Data on the predictive value of histopathological features of lymph node metastases, however, are inconsistent. The aim of this study was to evaluate the prognostic significance of known and new histopathological features of lymph node metastases in a well-defined cohort of PTC patients with clinically evident lymph node metastases. METHODS A total of 1042 lymph node metastases, derived from 129 PTC patients, were re-examined according to a predefined protocol and evaluated for diameter, extranodal extension, cystic changes, necrosis, calcifications and the proportion of the lymph node taken up by tumor cells. Predictors for a failure to achieve a complete biochemical and structural response to treatment were determined. RESULTS The presence of more than 5 lymph node metastases was the only independent predictor for a failure to achieve a complete response to treatment (OR 3.39 [95% CI 1.57-7.33], p < 0.05). Diameter nor any of the other evaluated lymph node features were significantly associated with the response to treatment. CONCLUSIONS Detailed re-examination of lymph nodes revealed that only the presence of more than 5 lymph node metastases was an independent predictor of failure to achieve a complete response to treatment. No predictive value was found for other histopathological features, including the diameter of the lymph node metastases. These findings have the potential to improve risk stratification in patients with PTC and clinically evident lymph node metastases.