From the Guidelines
Survival Rate for Papillary Thyroid Carcinoma (PTC) with Metastases to Lymph Nodes
The overall 10-year survival rate for papillary thyroid carcinoma (PTC) exceeds 90% to 95% 1. However, the presence of lymph node metastases can affect the prognosis.
Treatment and Management
Patients with PTC and lymph node metastases typically undergo total thyroidectomy and lymph node dissection, followed by adjuvant radioactive iodine (RAI) therapy with I-131, administered at a dose of 100-200 mCi 1. Post-operative management may include levothyroxine (T4) therapy at a dose of 1.6-2.0 mcg/kg/day to suppress thyroid-stimulating hormone (TSH) levels, and monitoring with serial thyroglobulin levels and neck ultrasound.
Risk Stratification
The risk of recurrence and mortality in PTC patients with lymph node metastases can be stratified using various systems, including the American Thyroid Association (ATA) risk stratification system 1. This system categorizes patients into low, intermediate, and high risk of recurrence based on factors such as tumor size, histology, and presence of lymph node metastases.
Survival Rate with Lymph Node Metastases
While the overall survival rate for PTC is high, the presence of lymph node metastases can decrease the 5-year survival rate to around 70-80% 1. However, with appropriate treatment and management, many patients with PTC and lymph node metastases can still achieve long-term survival and cure.
Key Points
- Total thyroidectomy and lymph node dissection are the primary treatments for PTC with lymph node metastases.
- Adjuvant RAI therapy with I-131 can help reduce the risk of recurrence and improve survival.
- Levothyroxine (T4) therapy and monitoring with serial thyroglobulin levels and neck ultrasound are important for post-operative management.
- Risk stratification systems, such as the ATA system, can help guide treatment and follow-up decisions.
From the Research
Survival Rate for Papillary Thyroid Carcinoma (PTC) with Metastases to the Lymph Node
- The survival rate for PTC with lymph node metastases is generally favorable, with a low frequency of persistent disease (PD) and tumor recurrence (TR) in patients without other factors for poor prognosis 2.
- A study of 86 patients with 5 or fewer lymph node metastases detected during intraoperative inspection found that PD was diagnosed in 3.5% of patients, and TR was observed in 2.5% of patients after 62 months of follow-up 2.
- Another study of 118 patients with PTC treated with radioactive iodine for lymph node metastases found that the overall effective rate was 80.5% after three times radioiodine therapy, with complete remission and partial response rates of 28.0% and 52.5%, respectively 3.
- A retrospective review of 83 consecutive PTC patients with at least one lymph node metastasis found that the 10-year and 15-year disease-specific survival rates after diagnosis of lymph node recurrence were 84.7% and 72.6%, respectively 4.
Factors Affecting Survival Rate
- Factors such as tumor size, extrathyroidal extension, and lymph node metastasis size can affect the survival rate of patients with PTC 2, 4, 5.
- A study found that patients with a small size of metastatic lymph node, younger patients, those with lower thyroglobulin levels, and patients with lymph node metastases detectable on the first postablative scan showed a good response to radioiodine ablation therapy 3.
- Another study found that older age and recurrent lymph node growth of more than 3 mm/year were recognized as independent predictors for short survival 4.
Treatment and Management
- Surgery is the primary treatment modality for PTC, and lymph node dissection (LND) is the mainstay treatment for clinically evident cervical lymph node metastases 6.
- Radioactive iodine and thyroid hormone suppression often complement the treatment plan, and watchful waiting with serial cervical ultrasound evaluations may be considered a reasonable approach to management of lymph node recurrence in selected patients 2, 4.