Abstract
BACKGROUND: This study aimed to evaluate predictive factors for failure in patients with N1b papillary thyroid carcinoma. METHODS: This retrospective study included patients presenting with lymph node metastases of papillary thyroid carcinoma in the lateral neck, and treated by thyroidectomy, central and lateral neck dissection in the Department of Otolaryngology, Head and Neck Surgery at Carmel Medical Center, between 2008-2021. RESULTS: Ninety-seven patients underwent 104 neck dissections. The mean age was 48 ± 18.8 years; 56 (57%) were women. The mean follow-up was 84.5 ± 48.3 months. Total nodal yield and the number of positive nodes were both inversely correlated with age (p < 0.0001). Twenty patients (21%) had treatment failure. Age (p = 0.0039), the number of positive nodes (p = 0.0042), extracapsular extension (p = 0.0085), and positive margins (p = 0.015) were predictors for failure in univariate and multivariate analyses. Among patients aged > 55 years, failures were more common (p = 0.024) and recurrence-free survival was significantly lower (p = 0.0044). Five- and ten-year disease specific survival rates were 96% and 85%, respectively. The age cutoff of 55 years predicted survival. CONCLUSIONS: Age, positive margins, number of positive nodes in neck dissection, and extracapsular extension correlated with treatment failure in clinical lateral neck nodal metastasis of papillary thyroid carcinoma. The number of positive nodes in neck dissection and the total nodal yield decreased with age. Patients with advanced regional disease at presentation, aged ≤ 55, have reduced risk for failure and better RFS, DSS and overall survival compared to patients aged >55 years.