Neck lymph node (LN) metastasis is a common feature of pediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the pediatric population. Our purpose is to investigate the association of LNR with clinical outcomes in pediatric papillary thyroid cancer.The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive-iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs, and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analyzed by univariate and multivariate analyses.Median number of positive LNs was 9, median LNR was 0.4. During a median follow-up of 49 months (range, 12.0-139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR > 0.34 exhibited a 3-fold higher risk of persistent disease after initial therapy than the counterparts (p = 0.02).Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.
Yangmenyuan Xu, Yu Wang, Xinyue Zhang, Rui Huang, Rong Tian, Bin Liu