title: Recent Changes in the Clinical Outcome of Papillary Thyroid Carcinoma With Cervical Lymph Node Metastasis.
abstract: BACKGROUND
  The prognosis of papillary thyroid cancer (PTC) with cervical lymph node (LN) metastasis has changed with increased detection of subclinical metastatic LNs. The number and size of metastatic LNs were proposed as new prognostic factors in PTC with cervical LN metastasis (N1).
  
  
  OBJECTIVE
  The objective of the study was to evaluate changes in N1 PTC characteristics and clinical outcome over time and to confirm the prognostic value of the number and size of metastatic LNs.
  
  
  METHODS
  This study included 1815 N1 PTC patients diagnosed between 1997 and 2011. Patients were classified into three risk groups according to the number and size of metastatic LNs: very low risk, five or fewer and 0.2 cm or less; low risk, five or fewer and 0.2 cm or greater; and high risk, more than five.
  
  
  METHODS
  Response to initial therapy and disease-free survival (DFS) was measured.
  
  
  RESULTS
  Metastatic LNs became smaller, and the ratio of metastatic LNs, which represents the extent of LN involvement and the completeness of surgery, decreased significantly over time. The proportion of patients with excellent response significantly increased from 33% to 67% over time (P < .001). These improvements were more evident in the low- and high-risk groups than in the very low-risk group. The DFS 5 years after initial surgery was also significantly increased from 73% to 91% over time (P < .001). The new LN classification was strongly associated with outcome. Patients in the very low-risk group had longer DFS than those in the low- and high-risk groups during the study period.
  
  
  CONCLUSIONS
  The clinical outcome of N1 PTC has significantly changed over time with the earlier detection of thyroid cancers with less extensive LN involvement. More complete surgical neck dissection also might be responsible for these changes. The number and size of metastatic LNs are important prognostic factors of recurrence in N1 PTC.
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Jeon
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Won Gu
authors.initials: WG
authors.lastname: Kim
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Yun Mi
authors.initials: YM
authors.lastname: Choi
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Hyemi
authors.initials: H
authors.lastname: Kwon
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Song
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Lee
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Tae-Yon
authors.initials: TY
authors.lastname: Sung
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Yoon
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Suck Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Baek
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Jin-Sook
authors.initials: JS
authors.lastname: Ryu
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Shong
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Ki-Wook
authors.initials: KW
authors.lastname: Chung
authors.affiliation: Departments of Internal Medicine (M.J.J., W.G.K., Y.M.C., H.K., T.Y.K., Y.K.S., W.B.K.), Pathology (D.E.S.), Surgery (Y.-M.L., T.-Y.S., J.H.Y., S.J.H., K.-W.C.), Radiology (J.H.B., J.H.L.), and Nuclear Medicine (J.-S.R.), Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Won Bae
authors.initials: WB
authors.lastname: Kim
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome