Level 7 disease does not confer worse outcome than level 6 disease in differentiated thyroid cancer Journal Article


Authors: Wang, L. Y.; Palmer, F. L.; Thomas, D.; Nixon, I. J.; Tuttle, R. M.; Shah, J. P.; Patel, S. G.; Shaha, A. R.; Ganly, I.
Article Title: Level 7 disease does not confer worse outcome than level 6 disease in differentiated thyroid cancer
Abstract: Background: Level 7 nodal disease increases patients from N1a to N1b in the American Joint Committee on Cancer (AJCC) TNM classification of differentiated thyroid cancers (DTCs). This results in upstaging of patients older than 45 years of age from stage III to IV. Our objective was to determine if patients with level 7 disease had poorer outcome in comparison to patients with isolated level 6 disease. Methods: A total of 599 patients with DTC limited to the central neck (level 6 and 7) were identified from an institutional database. Patients with N1b disease due to lateral compartment (level 1–5) involvement or M1 disease were excluded. Fifty-seven patients had positive level 7 disease, and 542 patients had nodal disease limited to level 6. Disease-specific survival (DSS) and recurrence-free survival (RFS) were calculated for each group. Results: Median age was 41 years (range 12–91) and follow-up was 61 months (range 1–330). There were no disease-specific deaths at 5 years. Among patients with level 6 disease at presentation, there were 42 nodal recurrences, and among patients with level 7 disease, there were two recurrences. There were no differences in overall RFS between patients with level 6 or 7 disease (5-year RFS 90.7 vs. 98.2 %, respectively; p = 0.096). Conclusions: Our results suggest that N1b disease due to level 7 disease does not confer worse DSS or RFS compared with patients with level 6 disease only. Classifying all central neck disease (levels 6 and 7) into the N1a category, and reserving the N1b classification only for patients with lateral neck disease may be more reflective of prognosis.
Keywords: adolescent; adult; cancer survival; child; controlled study; aged; cancer surgery; major clinical study; cancer recurrence; cancer staging; outcome assessment; follow up; lymph node metastasis; pathology; retrospective study; distant metastasis; radioactive iodine; external beam radiotherapy; disease specific survival; thyroid surgery; recurrence free survival; differentiated thyroid cancer; oncological parameters; human; male; female; article; level 6 disease; level 7 nodal disease
Journal Title: Annals of Surgical Oncology
Volume: 22
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2015-02-01
Start Page: 441
End Page: 445
Language: English
DOI: 10.1245/s10434-014-4045-3
PROVIDER: scopus
PUBMED: 25190124
DOI/URL:
Notes: Export Date: 2 February 2015 -- Source: Scopus
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MSK Authors
  1. Ashok R Shaha
    556 Shaha
  2. Snehal G Patel
    305 Patel
  3. Robert M Tuttle
    374 Tuttle
  4. Iain James Nixon
    60 Nixon
  5. Ian Ganly
    261 Ganly
  6. Jatin P Shah
    573 Shah
  7. Frank Palmer
    82 Palmer
  8. Dorothy Thomas
    9 Thomas
  9. Laura Wang
    34 Wang