title: Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer.
abstract: OBJECTIVE
  Cervical lymph node metastases are recognized as a prognostic indicator only in patients age 45 years or older with papillary thyroid cancer (PTC); patients younger than age 45 years are perceived to have low-risk disease. The current American Joint Committee on Cancer staging for PTC in patients younger than age 45 years does not include cervical lymph node metastases. Our objective was to test the hypothesis that the presence and number of cervical lymph node metastases have an adverse impact on overall survival (OS) in patients younger than age 45 years with PTC.
  
  
  METHODS
  Adult patients younger than age 45 years undergoing surgery for stage I PTC (no distant metastases) were identified from the National Cancer Data Base (NCDB; 1998-2006) and from SEER 1988-2006 data. Multivariable models were used to examine the association of OS with the presence of lymph node metastases and number of metastatic nodes.
  
  
  RESULTS
  In all, 47,902 patients in NCDB (11,740 with and 36,162 without nodal metastases) and 21,855 in the SEER database (5,188 with and 16,667 without nodal metastases) were included. After adjustment, OS was compromised for patients with nodal metastases compared with patients who did not have them (NCDB: hazard ratio (HR), 1.32; 95% CI, 1.04 to 1.67; P = .021; SEER: HR, 1.29; 95% CI, 1.08 to 1.56; P = .006). After adjustment, increasing number of metastatic lymph nodes was associated with decreasing OS up to six metastatic nodes (HR, 1.12; 95% CI, 1.01 to 1.25; P = .03), after which more positive nodes conferred no additional mortality risk (HR, 0.99; 95% CI, 0.99 to 1.05; P = .75).
  
  
  CONCLUSIONS
  Our results suggest that cervical lymph node metastases are associated with compromised survival in young patients, warranting consideration of revised American Joint Committee on Cancer staging. A change point of six or fewer metastatic lymph nodes seems to carry prognostic significance, thus advocating for rigorous preoperative screening for nodal metastases.
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Mohamed Abdelgadir
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: John
authors.initials: J
authors.lastname: Pura
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Paolo
authors.initials: P
authors.lastname: Goffredo
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Randall P
authors.initials: RP
authors.lastname: Scheri
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Terry
authors.initials: T
authors.lastname: Hyslop
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC.
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.affiliation: Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC. julie.sosa@duke.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000328:Adult; D000367:Age Factors; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery