Prevalence, Risk Factors And Location Of Skip Metastasis In Papillary Thyroid Carcinoma: A Systematic Review And Meta-Analysis

Yuxuan Qiu; Yuan Fei; Jingyan Liu; Chang Liu; Xin He; Ning Zhu; Wan-Jun Zhao; Jing-Qiang Zhu

doi:10.2147/CMAR.S200628

Prevalence, Risk Factors And Location Of Skip Metastasis In Papillary Thyroid Carcinoma: A Systematic Review And Meta-Analysis

Cancer Manag Res. 2019 Sep 25:11:8721-8730. doi: 10.2147/CMAR.S200628. eCollection 2019.

Authors

Yuxuan Qiu^#¹, Yuan Fei^#¹, Jingyan Liu², Chang Liu³, Xin He⁴, Ning Zhu⁵, Wan-Jun Zhao¹, Jing-Qiang Zhu¹

Affiliations

¹ Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
² Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
³ Public Policy and Administration, Department of Government, London School of Economics and Political Science, London, UK.
⁴ West China School of Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
⁵ Library and Information Science, School of Information Management, Nanjing University, Nanjing, People's Republic of China.

^# Contributed equally.

Abstract

Background: Skip metastasis is a special type in cervical lymph node metastasis (LNM) of patients diagnosed with papillary thyroid carcinoma (PTC) which induced poor prognosis. There are few studies about skip metastasis and conclusions remained uncertain. Therefore, this study aims to explore the frequency and to investigate risk factors of skip metastasis in PTC.

Methods: Through searching the keyword by PubMed and Embase databases which articles published up to 1^st August 2018 about skip metastasis in papillary thyroid carcinoma, we extract data in order to assure whether those materials meet the criteria.

Results: The prevalence of skip metastasis is 12.02% in light of our meta-analysis of 18 studies with 2165 patients. The upper pole location (RR = 3.35, 95% CI =1.65-6.79, P = 0.0008) and tumors size ≤1 cm (RR = 2.65, 95% CI =1.50-4.70, P = 0.0008) are significantly associated with skip metastasis, whereas lymphovascular invasion (RR = 0.33, 95% CI =0.15-0.75, P = 0.0083) exists lower rate of skip metastasis. Multifocality, gender, age, bilaterality, thyroiditis and Extrathyroidal extension (ETE) are insignificantly associated with skip metastasis. Level II and level III are the most frequently affected areas.

Conclusion: The lateral compartment should be carefully examined especially for those PTC patients who present primary tumors in the upper lobe with a primary tumor size ≤10 mm which could be detected with skip metastasis.

Keywords: lateral neck dissection; meta-analysis; papillary thyroid carcinoma; skip metastasis.