| Part 1 Clinicopathological features of papillary thyroid carcinoma with cervical lymph node metastasis in different age groupsObjectives:To compare the clinicopathological features of papillary thyroid carcinoma(PTC)with cervical lymph node metastasis in different age groups.Materials and Methods:This retrospective cohort study included patients with thyroid carcinoma who were hospitalized in the Department of Nuclear Medicine,Zhujiang Hospital of Southern Medical University from January 2014 to December 2019.Study subjects were determined according to inclusion and exclusion criteria.The Kaplan-Meier method in X-tile version 3.6.1 software was used to find the optimal cut-off value of cervical lymph node characteristics(the maximum diameter of metastatic lymph nodes,the maximum diameter of lymph node metastatic lesions,the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes,the number of lymph nodes dissected,the number of metastatic lymph nodes,and the ratio of the number of metastatic nodes to the number of dissected lymph nodes).According to the literature,the optimal cut-off age of PTC was 50 years old.The enrolled patients were divided into younger group(<50 years old group)and older group(≥50 years old group)according to their age.The χ2 test,the Mann-Whitney U test and other statistical methods were used to compare the differences of clinicopathological features between the two groups.All the statistical results were bilateral,and there was a statistically significant difference where the P value is less than 0.05.Results:A total of 1425 patients were included in this study,in which 961(67.4%)were females,464(32.6%)were males;1183(83.0%)were<50 years old,and 242(17.0%)were>50 years old.The optimal cut-off values of the maximum diameter of metastatic lymph nodes,the maximum diameter of lymph node metastatic lesions,the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes,the number of lymph nodes dissected,the number of metastatic lymph nodes,and the ratio of the number of metastatic nodes to the number of dissected lymph nodes were 1.3,0.8,0.59,27,8,and 0.275,respectively.According to the statistical results,we found that body mass index(BMI)(median 23.5 vs 22 kg/m2;P<0.001),extrathyroidal extension(54.2%vs 47.7%;P=0.013),nerve invasion(12.0%vs 6.7%;P=0.004),primary BRAFV600E mutation(73.1%vs 67.9%;P=0.01),T3b and above stages(8.7%vs 5.3%;P=0.049)in ≥50 years old group were significantly higher than those in<50 years old group.However,the proportions of the patients combined with Hashimoto’s thyroiditis(18.2%vs 28.1%;P=0.001),the number of lymph nodes dissected more than 27(20.2%vs 33.0%;P<0.001),the number of metastatic lymph nodes more than 8(18.6%vs 35.2%;P<0.001),the ratio of the number of metastatic nodes to the number of dissected lymph nodes more than 27.5%(59.1%vs 67.6%;P=0.011)and middle-risk patients(82.2%vs 88.1%;P=0.047)were less than those in<50 years old group.Conclusion:The number of extrathyroidal extension,nerve invasion,BRAFV600E mutation,T3b and above stage of the primary tumor in the older group were higher than that in the younger group.While the number of lymph nodes dissected,the number of metastatic lymph nodes,and the ratio of the number of metastatic nodes to the number of dissected lymph nodes in the younger group were higher than that in the older group.Part 2 Relationship between pathological features of cervical lymph nodes and prognosis in patients with PTC in different age groupsObjectives:To determine the factors affecting the prognosis of patients in PTC with cervical lymph node metastasis,and to explore the relationship between pathological features of cervical lymph nodes and prognosis of PTC patients in different age groups.Materials and Methods:The target study population,inclusion and exclusion criteria,lymph node characteristic groups and age groups are the same as in Part 1.Patients’ prognosis was divided into No Evidence of Disease(NED)and disease persistence/recurrence based on their response to treatment.Univariate and multivariate COX regression analysis were used to determine the factors affecting the prognosis of patients,and the relationship between cervical lymph node characteristics and prognosis of patients of different ages was compared.Results:After 48.1 months(median)follow-up,1038(72.8%)patients were considered as NED and 387(27.2%)patients had persistence/recurrence disease(including 135 cases of biochemical persistence,170 cases of structural persistence,19 cases of biochemical recurrence and 63 cases of structural recurrence).In this study cohort,Univariate analysis showed that gender,pathologic subtype,extrathyroidal extension,tumor thrombus/vessel invasion,nerve invasion,tumor location,multifocal,the maximum diameter of the primary lesion,location of metastatic lymph nodes,the maximum diameter of lymph node metastatic lesions,the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes,the number of metastatic lymph nodes,the ratio of the number of metastatic nodes to the number of dissected lymph nodes,extranodal extension,ATA recurrence risk stratification,levels of stimulated thyroglobulin(sTg)and thyroglobulin antibody(TgAb)before the first RAI treatment,and total dose of iodine treatment were related to prognosis.Besides,multivariate analysis showed that gender,pathological subtype,tumor location,location of metastatic lymph nodes,the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes,the ratio of the number of metastatic nodes to the number of dissected lymph nodes,levels of sTg and TgAb before the first RAI treatment,and total dose of iodine treatment were important factors influencing the prognosis.In terms of lymph node characteristics,in the younger group(<50 years old group),the significant risk factors for persistent/recurrence disease were the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes which was more than 59%,and the ratio of the number of metastatic nodes to the number of dissected lymph nodes which was more than 27.5%,while in the older group(≥50 years old group),it was only the maximum diameter of lymph node metastatic lesions that more than 0.8cm affected.Conclusion:In younger patients,the ratio of maximum diameter of metastatic lesions to maximum diameter of metastatic nodes and the ratio of the number of metastatic nodes to the number of dissected lymph nodes were independent factors for predicting disease persistence/recurrence.In older patients,the maximum diameter of lymph node metastatic lesions was an independent predictor of disease persistence/recurrence. |
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