title: The impact of nodal status on outcome in older patients with papillary thyroid cancer.
abstract: BACKGROUND
  The impact of clinically or radiologically detected nodal metastases on survival in patients with papillary thyroid cancer (PTC) is controversial but seems more important and relevant in older patients. The objective of this study was to determine the impact of clinically or radiologically detected nodal metastases on outcome in patients 45 years of age or older.
  
  
  METHODS
  Retrospective analysis of 834 patients 45 years or older who underwent operation for PTC between 1986 and 2005.
  
  
  RESULTS
  With a median follow up of 77 months, the 5 year disease-specific survival (DSS) and recurrence-free survival (RFS) were 99% and 94%, respectively. Patients with clinically N+ nodes with pathologic confirmation were stratified into pN0/Nx, pN1a, and pN1b, respectively. Five-year DSS was 100%, 100%, and 91% for pN0/Nx, pN1a, and pN1b disease; P < .001. Patients with pN1b disease had poorer distant RFS compared with pN0/Nx and pN1a patients (84%, 99%, and 99%; P < .001). The presence of pN1b disease was an independent predictor of worse DSS and distant RFS on multivariate analysis, conferring a 10-fold increased risk of distant metastases and death. All cause-specific deaths were due to distant metastases.
  
  
  CONCLUSIONS
  Older patients with PTC and N1b disease at presentation have poorer DSS compared with patients with pN0/Nx or N1a disease. The cause of death in these patients is due to distant metastases rather than locoregional recurrence.
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.affiliation: Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: ganlyi@mskcc.org.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy