Thyroid Cancer Coverage from Every Angle
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Connection Between Lymph Node Ratio and Mortality Risk in Papillary Thyroid Cancer?

By: Kayci Reyer
Posted: Wednesday, September 9, 2020

A recent study featured in JAMA Otolaryngology–Head & Neck Surgery reported no association between lymph node ratio and overall survival in patients with papillary thyroid cancer. In addition, an estimated 30% to 80% of patients develop cervical lymph node metastasis. Daniel J. Rocke, MD, of Duke University, Durham, North Carolina, and colleagues focused on data from the National Cancer Database to conduct the cohort study.

A total of 13,432 patients diagnosed with papillary thyroid cancer between January 2004 and December 2014 who had undergone lateral neck dissection were included in the study. The median value for the lymph node ratio was 0.35 (interquartile range, 0.20–0.59). A univariable analysis revealed that an increased lymph node ratio was not meaningfully associated with an increased risk of death (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.73–1.17), even after the investigators controlled for other prognostic factors (adjusted HR = 1.20; 95% CI = 0.94–1.53). Despite those findings, the increase in the 95% CI may indicate that an elevated lymph node ratio may have been associated with a clinically significant increased risk of death. After adjustments that incorporate the lymph node yield, or the number of nodes collected during neck dissection was made, no meaningful association was observed (adjusted HR = 1.32; 95% CI = 0.99–1.75).

The majority of the patients included in the study were women (60.6%). The median patient age was 45.3 years. A total of 769 patients (5.7%) in the study died of all causes.

Disclosure: For full disclosures of the study authors, please visit jamanetwork.com.

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