title: Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.
  
  
  METHODS
  The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow-up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra-thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.
  
  
  RESULTS
  Compared with the intra-thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease-specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow-up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.
  
  
  CONCLUSIONS
  In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra-thyroid tumor group.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, P. R. China.
authors.forename: Feng-Hsuan
authors.initials: FH
authors.lastname: Liu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital in Keelung, Chang Gung University, Taiwan, P.R. China.
authors.forename: Sheng-Fong
authors.initials: SF
authors.lastname: Kuo
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, P.R. China.
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, P.R. China.
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Chao
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, P. R. China.
authors.forename: Jen-Der
authors.initials: JD
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002291:Carcinoma, Papillary; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary; D013954:Thyroglobulin / Q000097:blood*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin
keywords: cancer specific survival; lymph node dissection; radioactive iodine; thyroglobulin; total thyroidectomy