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Purpose <p>The literature has revealed considerable discrepancies in the nodal extension (ENE) definition and risk stratification. This study aimed to assess the extent of ENE in patients with lateral cervical lymph node metastases (pN1b) and evaluate its relationship with survival outcomes.</p> Methods <p>A retrospective cohort analysis was conducted involving patients with pN1b PTC who underwent initial surgery between January 2000 and December 2018. Disease-specific survival (DSS) was analyzed using Kaplan–Meier survival curves, and compared using the log-rank test. The association between the extent of ENE and DSS was examined using Cox proportional hazards regression models.</p> Results <p>The study included 3,382 patients. Microscopic ENE (miENE) was identified in 808 patients (23.9%). Macroscopic ENE (maENE) was divided into maENEa (499 patients, 14.8%) and maENEb (84 patients, 2.5%). The overall 5-year DSS rate was 98.9%. Stratification by ENE extent revealed 5-year DSS rates of 99.8% for no ENE, 99.5% for miENE, 97.5% for maENEa, and 82.2% for maENEb, indicating significant differences (<i>p</i> &lt; 0.001). Cox regression analysis for DSS revealed significant associations with ENE extent, showing adjusted hazard ratios (HRs) of 3.49 (95% CI 1.28–9.51; <i>P</i> = 0.015) for the miENE group, 4.54 (95% CI 1.73–11.88; <i>P</i> = 0.002) for the maENEa group, and 20.54 (95% CI 7.95–53.10; <i>p</i> &lt; 0.001) for the maENEb group, compared to the no-ENE group.</p> Conclusion <p>The prognostic significance of ENE in PTC is highly variable and contingent on its extent. We propose stratification of maENE into maENEa and maENEb, with distinct DSS outcomes.</p>

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Prognostic significance of the extent of extranodal extension in patients with pN1b papillary thyroid carcinoma: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Yunhe Liu,
  • Xiwei Zhang,
  • Jie Liu,
  • Song Ni,
  • Hui Huang,
  • Shaoyan Liu

摘要

Purpose

The literature has revealed considerable discrepancies in the nodal extension (ENE) definition and risk stratification. This study aimed to assess the extent of ENE in patients with lateral cervical lymph node metastases (pN1b) and evaluate its relationship with survival outcomes.

Methods

A retrospective cohort analysis was conducted involving patients with pN1b PTC who underwent initial surgery between January 2000 and December 2018. Disease-specific survival (DSS) was analyzed using Kaplan–Meier survival curves, and compared using the log-rank test. The association between the extent of ENE and DSS was examined using Cox proportional hazards regression models.

Results

The study included 3,382 patients. Microscopic ENE (miENE) was identified in 808 patients (23.9%). Macroscopic ENE (maENE) was divided into maENEa (499 patients, 14.8%) and maENEb (84 patients, 2.5%). The overall 5-year DSS rate was 98.9%. Stratification by ENE extent revealed 5-year DSS rates of 99.8% for no ENE, 99.5% for miENE, 97.5% for maENEa, and 82.2% for maENEb, indicating significant differences (p < 0.001). Cox regression analysis for DSS revealed significant associations with ENE extent, showing adjusted hazard ratios (HRs) of 3.49 (95% CI 1.28–9.51; P = 0.015) for the miENE group, 4.54 (95% CI 1.73–11.88; P = 0.002) for the maENEa group, and 20.54 (95% CI 7.95–53.10; p < 0.001) for the maENEb group, compared to the no-ENE group.

Conclusion

The prognostic significance of ENE in PTC is highly variable and contingent on its extent. We propose stratification of maENE into maENEa and maENEb, with distinct DSS outcomes.