Risk factors for recurrence in patients with cT1—2N0M0 papillary thyroid cancer

A distinctive feature of papillary thyroid cancer (PTC) is frequent lymphatic metastasis. The presence of metastatic lymph nodes influences risk stratification and the frequency of disease recurrence. Objective. To identify the factors responsible for disease recurrence in patients with early-stage papillary thyroid cancer. Material and methods. A Single Centre Study, uncontrolled, prospective study of 319 patients with cT1-2N0M0 PTC was conducted. All patients underwent thyroidectomy with prophylactic central neck dissection (CND). In the postoperative period, 271 patients underwent radioiodine therapy. The gender, age, tumor size, multicentricity, extrathyroid invasion, morphological type, and status of regional lymph nodes in the VI region were analyzed. The median follow-up was 70 months. Results. «Hidden» metastases in the central zone after prophylactic CND were detected in 116 (36.4%) patients. During the follow-up period, recurrence was detected in 10 (3.1%) patients and was significantly more common in patients with pN1a compared to pN0 (7.8% vs 0.5%; p<0.001). Involvement of ≥2 lymph nodes in region VI was found to be a predictor of recurrence (p<0.001). Additional risk factors for recurrence were male gender (p=0.022), age <55 years (p=0.032), and tumor size > 2 cm (p=0.028). The 5-year recurrence-free survival rate was 87.7% for patients with involvement of ≥2 metastatic lymph nodes, compared with 100% for those with involvement of <2 lymph nodes (p<0.001). Conclusions. The most significant prognostic factors for recurrence of PTC in patients with cT1-2N0M0 disease, in order of importance, are: the presence of two or more central lymph nodes metastatic, male gender, young age, and a tumor size greater than 2 cm. Taking these factors into account is important for predicting the risk of recurrence and may influence treatment strategies.