Metastatic lymph node ratio can further stratify risk for mortality in medullary thyroid cancer patients: A population-based analysis
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Ning Qu1,*, Rong-liang Shi1,2,*, Zhong-wu Lu1, Tian Liao1, Duo Wen1, Guo-hua Sun1, Duan-shu Li1, Qing-hai Ji1
1Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Department of General Surgery, Minhang Hospital, Fudan University, Shanghai 201199, China
*These authors have contributed equally to this work
Qing-hai Ji, email: firstname.lastname@example.org
Duan-shu Li, email: email@example.com
Keywords: medullary thyroid cancer, lymph node dissection, ratio, SEER, survival analysis
Received: February 24, 2016 Accepted: August 09, 2016 Published: August 31, 2016
Medullary thyroid cancer (MTC) has a propensity to cervical lymph node metastases (LNM). Recent studies have shown that both the number of involved lymph nodes (LNs) and the metastatic lymph node ratio (MLNR) confer prognostic information. This study was to determine the predictive value of MLNR on cancer-specific survival (CSS) in SEER (Surveillance, Epidemiology and End Results)-registered MTC patients treated with thyroidectomy and lymphadenectomy between 1991 and 2012, investigate the cutoff points for MLNR in stratifying risk of mortality and provide evidence for selection of appropriate treatment strategies. X-tile program determined 0.5 as optimal cut-off value for MLNR in terms of CSS in 890 MTC patients. According to multivariate Cox regression analysis, MLNR (0.50–1.00) is a significant independent prognostic factor for CSS (hazard ratio 2.161, 95% confidence interval 1.327–3.519, p=0.002). MLNR (0.50–1.00) has a greater prognostic impact on CSS in female, non-Hispanic white, T3/4, N1b and M1 patients. The lymph node yield (LNY) influences the effect of MLNR on CSS; LNY ≥9 results in MLNR (0.50–1.00) having a higher HR for CSS than MLNR (0.00-0.49). In conclusion, higher MLNRs predict poorer survival in MTC patients. Eradication of involved nodes ensures accurate staging and maximizes the ability of MLNR to predict prognosis.
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