title: Not all DTC patients with N positive disease deserve the attribution "high risk". Contribution of the MSDS trial.
abstract: OBJECTIVE
  To investigate if patients with thyroid carcinoma having N1a disease are at the same risk with N1b using the collective of the well-defined European prospective Multicentre Study Differentiated Thyroid Cancer (MSDS).
  
  
  METHODS
  Overall (OS) and event free survival (EFS) were calculated. Cox multivariable regression analysis was performed in order to calculate Hazard ratios (HR).
  
  
  RESULTS
  EFS was significantly decreased only in patients with N1b metastasis as compared to N0 patients and became worse when N1a was concomitantly affected. A superior survival in favor of N1a patients as compared to N1b patients with regard to EFS was also observed. The patients having N1a disease showed no differences in the EFS as compared to N0. OS did not differ significantly in any of the groups. There was an increased HR for events with regards to histology, T-stage, tumor size, UICC stage and cervical lymph node metastasis. Tumor size showed a significantly increased risk for OS.
  
  
  CONCLUSIONS
  Patients with pT3b and pT4a tumors with N1b are of higher risk for relapse, albeit not affecting overall survival. Patients with N1a are of no higher risk. The risk stratification of these patients may be adapted accordingly.
authors.affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Vrachimis
authors.affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wenning
authors.affiliation: Institute of Biostatistics and Clinical Research, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Gerß
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Vaez Tabassi
authors.affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Otmar
authors.initials: O
authors.lastname: Schober
authors.affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Riemann
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: N1a; N1b; event free survival; overall survival; thyroid carcinoma