title: The presence of cancerous nodules in lymph nodes is a novel indicator of distant metastasis and poor survival in patients with papillary thyroid carcinoma.
abstract: OBJECTIVE
  Several characteristics of lymph node metastasis (LNM) as predictors of the risk of recurrence or death were examined in patients with papillary thyroid carcinoma (PTC). The presence of cancerous nodules as a characteristic of LNMs in PTC has not yet been reported. The objective of this study was to evaluate the use of the cancerous nodules in the lymph node (CNLN) to determine the risk of distant metastasis and survival in patients with PTC.
  
  
  METHODS
  This retrospective observational cohort study enrolled 1408 patients with pathologically confirmed PTC without initial distant metastasis who underwent thyroidectomy and neck dissection. All patients were divided into two groups (CNLN group and Non-CNLN group) according to the presence of CNLN.
  
  
  RESULTS
  Multivariate analyses showed that the presence of a special histologic variant (OR 3.31), CNLN (OR 7.13), and lateral LNM (OR 4.02) was an independent factor predictive of distant metastasis. Distant metastasis was found in 23.1% and 2.3% of patients in the CNLN and Non-CNLN group, respectively (p < 0.001). Furthermore, tumor-specific death was found in 7.7% and 0.6% of patients in the CNLN and Non-CNLN group, respectively (p < 0.001). Patients in the CNLN group had a shorter distant metastasis-free survival and overall survival than patients in the Non-CNLN group (p < 0.001).
  
  
  CONCLUSIONS
  The presence of CNLN in patients with PTC is a novel indicator of distant metastasis and poor survival. PTC patients accompanied with CNLN should undergo more aggressive treatment and careful follow-up.
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Youzhi
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Pathology, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, Fujian Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Huihao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Hongkun
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Pathology, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, Fujian Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Kunlin
authors.initials: K
authors.lastname: Wu
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Lingjun
authors.initials: L
authors.lastname: Kong
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Weihong
authors.initials: W
authors.lastname: Ruan
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Jianying
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Thyroid and Breast Surgery, The First Affiliated Hospital of FuJian Medical University, No. 20, Chazhong Road, ChaTing Street, FuZhou City, 350000, FuJian Province, China. xiangjinchen473@yeah.net.
authors.forename: Xiangjin
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
keywords: Distant metastasis; Lymph node metastasis; Papillary thyroid cancer; Predictor; Survival