Papillary thyroid carcinoma (PTC) is a malignancy that has good prognosis e
specially among patients up to 45 years of age; about half of the patients
are female and of childbearing age. Lymph node recurrence (LNR) occurs in 1
0%-14% of patients but is considered to be associated with relatively good
prognosis. The purpose of this study was to estimate the association betwee
n patient age at primary operation, and the behavior of the disease after L
NR. Between 1967 and 1994, 495 patients underwent surgery for primary PTC a
t the Department of Surgery, Helsinki University Central Hospital. There we
re 391 (79.0%) women and 104 (21.0%) men with a mean age of 44.5 years (ran
ge, 10.8-85.4 years). Fifty-eight patients in whom LNR was the first clinic
al sign of persistent disease after complete clinical response to primary t
reatment were included in this series. At the time of primary operation, 37
(64.3%) of the 58 patients who developed LNR were younger than 45 years of
age and 21 patients were older. The mean times to LNR in these groups were
42.0 months (range, 3.0-194.5 months) and 49.0 months (range, 3.6-209.0 mo
nths) respectively. Carcinoma-specific 5-year survival after LNR was 100% (
95% confidence interval [CI] 88.8%-100.0%) in patients ages up to 45 years
and 61.1% (40.5%-82.8%) in older patients; 10-year survival rates were 100%
, and 41.3% (p < 0.0001), respectively. Relative survival at 10 years was 9
8.6% for patients ages up to 45 years and 42.6% for older patients (p = 0.0
014). Using the Cox model it was shown that development of LNR after primar
y treatment has an independent highly significant negative effect on surviv
al (p < 0.001) in patients over 45 years of age. Prognosis of PTC even afte
r LNR on patients ages up to 45 years at the time of the primary operation
is almost parallel to the normal reference population, but in patients over
45 years of age the prognosis is relatively poor.