Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis

// Guibin Zheng 1, * , Hua Zhang 2, * , Shaolong Hao 1 , Chengxin Liu 1 , Jie Xu 1 , Jinyao Ning 1 , Guochang Wu 1 , Lixin Jiang 1 , Guojun Li 3, 4 , Haitao Zheng 1 and Xicheng Song 2 1 Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province, 264000, China 2 Department of Otolaryngology-Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province, 264000, China 3 Departments of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, U.S.A. 4 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, U.S.A. * These authors contributed equally to this work and are considered co-first authors Correspondence to: Haitao Zheng, email: zhenghaitao1972@126.com Xicheng Song, email: songxicheng@126.com Keywords: Delphian lymph node, papillary thyroid cancer, central neck node metastases, lateral neck node metastases Received: February 22, 2017      Accepted: June 19, 2017      Published: July 06, 2017 ABSTRACT Although the roles of Delphian lymph node (DLN) metastasis in papillary thyroid cancer (PTC) have been previously reported, there are still limited data on correlations of clinicopathologic factors with DLN metastasis and unique patterns of cervical node subsite metastasis in PTC patients with DLN metastasis. We retrospectively reviewed medical records of 320 patients with a diagnosis of PTC who underwent primary surgery. Clinicopathologic features and DLN metastasis patterns were analyzed for predicting extensive cervical lymph node metastasis. Both univariate and multivariate Cox regression analyses were used to identify independent factors for cervical lymph node metastasis. DLN metastasis was significantly associated with multifocality, tumor size > 1 cm, extrathyroid extension, BRAF V600E mutation, central neck node metastasis (CNNM), and lateral neck nodes metastases. Patients with DLN metastasis had more lymph node metastases in the central compartment. CNNM number and tumor size > 1 cm were independent risk factors for DLN metastasis. DLN metastasis was highly predictive of lateral lymph node metastasis with moderate sensitivity and high specificity. DLN metastasis is associated with several poor prognostic factors, including extensive cervical lymph node metastasis, and can serve as a predictor of advanced PTC. The presence of DLN metastasis should prompt surgeons to perform an aggressive surgery approach.