title: Extranodal tumor extension to adjacent organs predicts a worse cause-specific survival in patients with papillary thyroid carcinoma.
abstract: BACKGROUND
  We previously reported that massive extrathyroid extension has an independent prognostic value in patients with thyroid papillary carcinoma. However, tumor extension to adjacent organs can be observed not only in primary tumor but also in metastatic nodes. In this study we investigated the clinical significance of extranodal tumor extension to adjacent organs (nodal ex) in papillary thyroid carcinoma.
  
  
  METHODS
  We classified all cases into three categories based on the degree of nodal ex: nodal ex0, no apparent extranodal tumor extension; nodal ex1, hard metastatic nodes with perinodal growth extending to adjacent organs, which require separation of the nodes from the organs; and nodal ex2, metastatic nodes with perinodal growth completely invading the adjacent organs and requiring excision of nodes together with these organs. We investigated the clinical significance of each grade in 1,692 patients who underwent initial surgery for papillary carcinoma between 1987 and 1995.
  
  
  RESULTS
  The presence of nodal ex was significantly linked to various clinicopathological features such as male gender, N1b, large number of metastatic nodes, pT4a, and distant metastasis. On univariate analysis, patients with either nodal ex1 or ex2 showed significantly worse disease-free and cause-specific survival rates, although these rates did not differ between patients with nodal ex1 and those with nodal ex2. Furthermore, multivariate analysis demonstrated that nodal ex independently predicts worse cause-specific survival of these patients.
  
  
  CONCLUSIONS
  Presence of nodal ex significantly reflects the biologically aggressive behaviors of papillary carcinoma and has a prognostic value, especially for cause-specific survival of patients.
authors: Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dor, Chuo-ku, Kobe City, Japan. ito01@kuma-h.or.jp
authors: Yasuhiro
authors: Y
authors: Ito
authors: Mitsuyoshi
authors: M
authors: Hirokawa
authors: Tomoo
authors: T
authors: Jikuzono
authors: Takuya
authors: T
authors: Higashiyama
authors: Yuuki
authors: Y
authors: Takamura
authors: Akihiro
authors: A
authors: Miya
authors: Kaoru
authors: K
authors: Kobayashi
authors: Fumio
authors: F
authors: Matsuzuka
authors: Kanji
authors: K
authors: Kuma
authors: Akira
authors: A
authors: Miyauchi
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy