Lymph node status influences follow-up thyroglobulin levels in papillary thyroid cancer.

摘要

BACKGROUND: Elevated thyroglobulin (Tg) levels post surgery are associated with disease recurrence in papillary thyroid carcinoma (PTC). The aim of this study is to determine which clinicopathological factors influence Tg elevation following surgery and radio-iodine ablation (RAI) for PTC. METHODS: A retrospective study of consecutive patients undergoing total thyroidectomy and RAI for PTC was carried out. Prophylactic central neck dissection (CND) was performed if the diagnosis of PTC was made preoperatively. Lateral neck dissection (LND) was guided by ultrasound findings. RAI was administered 6 weeks postoperatively. Stimulated Tg levels were measured at 12 months. RESULTS: One hundred patients with PTC were studied. Forty patients had routine CND. The median tumour size was 15 mm. Median stimulated Tg level at 12 months was 0.3 mug/L. On multivariate analysis the number of metastatic lymph nodes removed had a significant positive association with serum Tg levels (P = 0.003). The total number of lymph nodes resected had a significant inverse relationship with serum Tg levels (P = 0.04). Tumour size, multifocality, vascular and capsular invasion did not appear to have significant correlation with Tg levels. CONCLUSION: Lymph node metastases are associated with increased postablative Tg levels in PTC. More complete lymphadenectomy is associated with lowering of Tg levels.