Cj. Hughes et al., IMPACT OF LYMPH-NODE METASTASIS IN DIFFERENTIATED CARCINOMA OF THE THYROID - A MATCHED-PAIR ANALYSIS, Head & neck, 18(2), 1996, pp. 127-132
Background. Cervical lymph node metastasis in differententiated thyroi
d carcinoma has mostly been found to have little relationship to progn
osis. However, some studies report nodal involvement to be an adverse
factor, while others have found it to be favorable. We have undertaken
a matched-pair analysis of previously untreated patients, with and wi
thout ipsilateral neck metastasis, to examine the significance of noda
l spread in patients with otherwise equivalent prognostic factors for
differentiated thyroid cancer. Method. From a database of 931 patients
, treated from 1930 to 1980, we used a computer to match patients with
confirmed lateral neck metastasis (N1) to those who were stage NO, an
d had the following identical prognostic factors: no distant metastasi
s, age (within 4 years), and tumor size, histology, and intrathyroidal
extent. When possible, matches were also made for gender, multifocali
ty, and extent of thyroid surgery. Survival and treatment failures wer
e analyzed, with and without stratification for age. Results. We were
able to select 100 N1 patients with corresponding NO patients, sharing
the major prognostic risk factors as listed. Overall, there was no di
fference in survival, although N1 patients more often had recurrence.
Mortality increased with age. Analysis at high-risk age (45 years and
older) showed significantly more recurrences in N1 patients (p = .008)
. Twenty-year survival in N1 patients over the age of 45 was lower tha
n that of NO patients. On the other hand, under the age of 45, N1 pati
ents had better survival. These differences, however, did not reach st
atistical significance. Conclusion. Nodal involvement in older patient
s with thyroid cancer increases the risk of recurrence, although no si
gnificant difference in survival is observed in relation to age. (C) 1
996 John Wiley & Sons, Inc.