Associations of clinicopathologic features and mutation status with lateral lymph node metastasis as a predictor of disease-free survival in papillary thyroid carcinoma

Abstract

Background: Lateral lymph node metastasis (LLNM) is a significant risk factor for poor prognosis in papillary thyroid carcinoma (PTC). Data on the association between LLNM and genetic alterations in PTC remains limited. This study investigated clinicopathological and molecular predictive factors for LLNM in patients with PTC.

Methods: We conducted a single-center retrospective analysis of 603 patients who underwent thyroid surgery between January 2018 and December 2023. Clinicopathological features and genetic mutations, including BRAF^V600E and telomerase reverse transcriptase (TERT) promoter mutations, were assessed to identify predictors of LLNM. The impact of these features on disease-free survival (DFS) was analyzed using multivariable Cox regression.

Results: LLNM was found in 154 (25.5 %) patients. Independent predictors of LLNM included age < 55 years (odds ratio [OR] = 2.491, 95 % confidence interval [CI]: 1.411-4.398), multifocality (OR = 2.056, 95 % CI: 1.254-3.370), lymphatic invasion (OR = 1.811, 95 % CI: 1.094-2.997), gross extrathyroidal extension (ETE) (OR = 2.611, 95 % CI: 1.333-5.115), central lymph node metastasis (CLNM) without extranodal extension (ENE) (OR = 12.060, 95 % CI: 4.205-34.595) or with ENE (OR = 68.060, 95 % CI: 23.224-199.453), and TERT promoter mutation (OR = 2.272, 95 % CI: 1.078-4.786). CLNM with ENE, LLNM with ENE and TERT promoter mutation were significantly correlated with shorter DFS.

Conclusions: LLNM is not rare in PTC and represents an adverse prognostic factor significantly associated with age, gross ETE, multifocality, lymphatic invasion, CLNM, and TERT promoter mutation.

Keywords: BRAF(V600E); Lateral lymph node metastasis; Papillary thyroid carcinoma; Recurrence; TERT.