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The impact of age at diagnosis on central lymph node metastasis in clinically low-risk papillary thyroid microcarcinoma patients

Thyroid Research volume 18, Article number: 6 (2025) Cite this article

Abstract

Background

Age is an independent risk factor for central lymph node metastasis (CLNM) in clinically negative lymph node (cN0) papillary thyroid microcarcinoma (PTMC) patients. The objective of this study was to investigate the impact of age on CLNM in clinically low-risk PTMC patients.

Methods

A retrospective analysis was performed on patients with clinically low-risk PTMC who underwent surgery between January 2016 and December 2018. Logistic regression analysis was used to examine the impact of age on the risk of CLNM. The associations between age and pN1a and the lymph node ratio (LNR) were examined by a restricted cubic spline (RCS) curve with logistic regression models.

Results

A total of 1352 patients (mean [range] age, 43[18-76] years; 325 males [24.0%]) were enrolled in this study. Logistic regression analysis revealed that age was a significant factor influencing the risk of CLNM (OR 0.95, 95% CI 0.94–0.96; p < 0.001). The RCS curve revealed a significant nonlinear association between age and pN1a status and the LNR. For patients under the age of 55, the risk of CLNM (OR 0.59, 95% CI 0.55–0.65, p < 0.001) and the LNR (beta − 0.23, 95% CI -0.27, -0.19, p < 0.001) significantly decreased as age increased. For patients aged ≥ 55 years, the risk of LNM (OR 1.03, 95% CI 0.81–1.32; p = 0.79) and the LNR (Beta − 0.03, 95% CI -0.07,0.13, p = 0.54) did not change with age.

Conclusions

This study confirmed that age was a significant factor influencing the risk and severity of CLNM in patients with low-risk PTMC. The risk and severity of LNM were lowest in patients aged ≥ 55 years.

Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma measuring ≤ 10 mm in greatest dimension [1]. PTMC has contributed significantly to the increased incidence of papillary cancer in recent decades [2]. Active surveillance (AS) has been suggested as an appropriate initial approach for clinically low-risk PTMC patients given its favorable prognosis [3, 4]. Furthermore, the literature suggests that age is a crucial indicator of progression in patients with low-risk PTC under AS. Several prospective studies have shown that younger individuals are more likely to experience disease progression [5, 6]. Thus, guidelines recommend that AS is ideal for patients aged 60 years and older but not for younger patients [3, 7, 8].

Previous studies revealed that the incidence of central lymph node metastasis (CLNM) was approximately 18.3–50.0% in clinically negative lymph node (cN0) PTMC patients [9,10,11]. Although some studies have shown that CLNM does not affect overall survival, studies have reported that lymph node metastasis is associated with increased local recurrence rates and decreased recurrence-free survival rates [12, 13]. Extranodal extension (ENE) is recognized as a significant prognostic factor for PTC [14], and microscopic ENE has also been identified as an independent risk factor for locoregional recurrence [15]. Patient age has been proven to be one of the independent risk factors associated with CLNM in patients with cN0 PTC [9, 16,17,18,19]. And, some genetic alterations, such as BRAF mutations and TERT promoter mutations, are also associated with increased clinical aggressiveness of PTC [20, 21]. At present, there is limited research focusing on occult lymph node metastasis in clinically low-risk PTMC patients. Determining the status of lymph nodes is crucial in making informed decisions regarding the treatment of clinically low-risk PTMC. This information may significantly contribute to developing personalized treatment and care strategies.

In this study, we conducted a retrospective analysis to investigate the impact of age at diagnosis on occult central lymph node metastasis in patients with clinically low-risk PTMC treated with surgery. We aimed to gain a better understanding of the role of age at diagnosis in decision-making for the management of clinically low-risk PTMC patients.

Materials and methods

Patients

We conducted a retrospective analysis of a cohort of patients who underwent initial surgery for PTMC at a cancer center between January 2016 and December 2018. Patients who met the eligibility criteria for initial thyroid lobectomy in the National Comprehensive Cancer Network (NCCN) guidelines [22] and for active surveillance as recommended by the American Thyroid Association (ATA) thyroid cancer management guidelines [23] were enrolled in the study. Patients with bilateral tumors, multifocal tumors identified on preoperative ultrasound examination, gross extrathyroidal extension (gETE) identified on preoperative imaging, clinical LNM, gross ENE (identified preoperatively if the metastatic lymph nodes were fused together or invaded nearby tissues or structures, such as the recurrent laryngeal nerve, strap muscles, trachea, or esophagus), distant metastases, a history of radiation therapy on the neck, or a history of familial thyroid cancer were excluded. Patients with incomplete demographic data or pathological results were also excluded. All the included patients underwent lobectomy (with isthmectomy) and ipsilateral central neck dissection. Postoperative treatments included appropriate levels of thyrotropin suppression.

Data collection

Data, including age, sex, and pathological characteristics, were obtained from medical records. Pathological diagnosis was determined based on standard World Health Organization criteria [24]. The pathological characteristics included histological variant, tumor location (lower, middle, upper or multifocal), tumor size, Hashimoto’s thyroiditis (HT), multifocality, microscopic ETE (mETE), lymphovascular invasion (LVI), cervical lymph node status (pN stage, number of metastatic lymph nodes [LNs] and ENE). The clinical lymph node status was primarily evaluated through preoperative ultrasound (US) examination [25]. Additionally, any palpable firm lymph nodes, evidence of lymph node fusion, or identification of invasive lymph nodes during surgery were considered clinical LNM. In this study, LNM with ≥ 5 metastatic lymph nodes (LNs) or ENE was defined as high-risk LNM. The lymph node ratio (LNR) was defined as the number of metastatic LNs divided by the total number of LNs. Restaging was performed using the American Joint Committee on Cancer TNM Stage for Thyroid Cancer (8th Edition, 2017) [26]. The initial risk stratification was performed in accordance with the 2015 ATA guidelines [23].

Statistical analysis

We selected age cutoff points of 30 and 55 years, and the entire patient cohort was divided into three groups according to their age distribution: ≤30 years (young patients), 31–54 years (middle-aged patients), and ≥ 55 years (older patients). Categorical variables are expressed as frequencies and proportions, and the chi-square test or Fisher’s exact test was used for comparisons. Continuous variables are presented as the mean ± standard deviation and median and were compared with one-way ANOVA. Multivariate logistic regression analysis was used to examine the impact of age at diagnosis on the risk of lymph node metastasis. The confounding variables included sex, tumor location, tumor size, aggressive variant, LVI, HT and mETE. The associations between age and pN stage and the LNR were examined by a restricted cubic spline (RCS) curve with logistic regression models. A two-piecewise logistic regression model was used on both sides of the inflection point, and a log likelihood ratio test was performed. In our study, all the statistical analyses were performed using R software, version 4.2.2, and the Match It package along with the use of MSTATA software. All the statistical tests were two-sided, and a P value of less than 0.05 indicated statistical significance.

Results

Demographic and pathological characteristics

A total of 1352 patients who met the inclusion criteria were enrolled in this study. Among them, 325 (24.0%) were male. The mean age was 43 years (range 18 to 76 years). The mean tumor size was 0.61 cm (range 0.1–1.0 cm). A total of 328 patients (25.0%) had coexisting HT. Aggressive variants, LVI, and mETE were present in 12 (0.9%), 5 (0.4%) and 467 (34.5%) patients, respectively. A total of 487 patients (36.0%) had pathological CLNM (pN1a). Fifty (3.7%) patients had 5 or more metastatic LNs. Forty-three patients (3.2%) had ENE, and 85 patients (6.3%) had high-risk LNM. The mean LNR was 0.14. A total of 1310 patients (96.9%) were classified as stage I, and 42 patients (3.1%) were classified as stage II. According to the 2015 ATA risk stratification system, 856 patients (63.3%) were classified as low risk, and 496 patients (36.7%) were classified as intermediate risk. The details of the characteristics are presented in Table 1. There were no significant differences among the groups in terms of sex, tumor location, tumor size, HT, aggressive variant or LVI (p>0.05). The proportion of patients with mETE was greatest in the older group and lowest in the young group, but the difference was not significant (p = 0.09). The proportion of pN1a stage was highest in young patients (54.9%) and lowest in older patients (21.1%). Similarly, the number of metastatic LNs (1.43 ± 1.81) and the LNR (0.24 ± 0.30) were highest in young patients and lowest in older patients (0.43 ± 1.08 and 0.07 ± 0.19, respectively). The proportion of high-risk LNM was highest in young patients (12.1%) and lowest in older patients (4.0%). All of these differences were statistically significant.

Table 1 Patient demographics and baseline characteristics
Full size table

Impact of age on lymph node metastasis

Logistic regression analysis revealed that age was a significant factor influencing the risk of CLNM (OR 0.95, 95% CI 0.94–0.96, p < 0.001) after adjusting for confounding variables. Additionally, older patients (OR 0.22, 95% CI 0.14–0.34, p < 0.001) and middle-aged patients (OR 0.46, 95% CI 0.33–0.63, p < 0.001) were found to have a significantly lower risk of CLNM than young patients (Table 2).

Table 2 Association between age group and pN1a stage (logistic regression analysis)
Full size table

Relationships between age at diagnosis and pN1a status and the LNR

We used RCS to create a flexible model and visualized the relationships between age at diagnosis and pN1a and LNR based on a logistic regression model adjusted for the effects of sex, tumor location, tumor size, aggressive variant, LVI, HT and mETE. A significant nonlinear association was observed between age and pN stage (p value for age < 0.001, p value for nonlinearity = 0.006; Fig. 1A) and between age and the LNR (p value for age < 0.001, p value for nonlinearity < 0.001; Fig. 1B). The inflection point of the RCS curve was identified at age = 55. For patients under the age of 55, as age increased, the risk of CLNM (pN1a) showed a significant decreasing trend (OR 0.59, 95% CI 0.55–0.65, p < 0.001). In contrast, for patients aged ≥ 55 years, the risk of CLNM did not change with age (OR 1.03, 95% CI 0.81–1.32; p = 0.79) (Table 3). For patients under 55 years old, the LNR gradually decreased with age (Beta − 0.23, 95% CI -0.27, -0.19, p < 0.001), while for patients aged ≥ 55 years, the LNR did not change with age (Beta 0.03, 95% CI -0.07,0.13, p = 0.54) (Table 4).

Fig. 1
figure 1

Association between age and pN stage (A) and LNR(B) with the RCS function. (A) Model with 6 knots at the 5th, 23rd, 41st, 59th, 77th and 95th percentiles. Y-axis represents the OR to present pN1a stage for any value of age compared to individuals with reference value (50th percentile) of age. (B) Model with 3 knots at the 10th, 50th and 90th percentiles. Y-axis represents the beta to present LNR for any value of age compared to individuals with reference value (50th percentile) of age. The logistic regression was adjusted for sex, tumor location, tumor size, aggressive variant, LVI, HT and mETE

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Table 3 Effect of standardized age on pN stage and the LNR
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Discussion

Age at diagnosis has been identified as a significant risk factor for CLNM in patients with cN0 PTMC, and the majority of studies use age 45 or 55 years as a cutoff point, considering patients younger than 45 or 55 years to be at a significantly greater risk [9, 18]. Several researchers have also examined age as a continuous variable and have shown that as age increases, the risk of metastasis gradually decreases (OR 0.977, 95% CI 0.963–0.992, p = 0.003) [16, 17].

Active surveillance (AS) has proven to be safe and effective for low-risk PTMC patients [3, 4]. Several prospective studies have shown that younger patients are more likely to experience disease progression [5, 6, 27]. Therefore, most guidelines suggest using AS for older patients and discourage its use for younger patients but do not offer definitive age-specific recommendations. For example, guidelines from the Japan Association of Endocrine Surgery Task Force recommend AS for older patients and generally advise against it for patients under the age of 18 to 20 [27]. The SBEM (2022) and Korean Thyroid Association (KTA) (2023) guidelines state that AS is ideal for patients aged 60 and above and can be considered appropriate for those aged between 18 and 59 [7, 8]. This may be due to a deficiency in definitive and reliable clinical evidence.

The present study focused on low-risk PTMC patients who met the criteria for AS but who received surgical treatment. We investigated the relationships between age at diagnosis and pathological lymph node metastasis, including LNM rate and the LNR, by employing robust statistical methods. Our findings indicate that younger patients have a highest rate of CLNM, highest number of metastatic LNs and a greater proportion of high-risk LNM. The RCS curve revealed that for patients under the age of 55, the risk of CLNM and the LNR decrease gradually with age, suggesting that young patients may experience faster tumor progression. Therefore, caution should be exercised when considering active surveillance (AS) for younger patients. Conversely, patients aged 55 and older had lowest rates of CLNM, lowest number of metastatic LNs and a lowest proportion of high-risk LNM. Additionally, the RCS curve demonstrated that for patients aged 55 and older, there was no significant change in the risk of LNM or the LNR with increasing age, indicating a stable trend in tumor progression for this age group. This comprehensive analysis not only underscores the potential risk of metastasis but also illuminates the severity of metastasis. The results may provide evidence for the selection of treatment strategies for low-risk PTC patients in terms of age.

Our study has several limitations. Due to the retrospective nature of the data, factors such as sample size and preoperative imaging evaluations (specifically ultrasonography) were not preplanned, and we did not consider differences among surgical operators, which could impact the accuracy of tumor assessment and lead to selection bias. Additionally, data on characteristics such as BRAF status and TERT promoter mutations were not obtained. These limitations could affect the final results and limit the generalizability of the conclusions.

Conclusion

This study revealed that age at diagnosis is a significant factor influencing the risk and severity of CLNM in patients with low-risk PTMC. The risk and severity of CLNM were lowest in older patients (aged ≥ 55 years). In the future, it is necessary to conduct prospective studies to validate the findings of our study and obtain reliable and generalizable conclusions.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

PTMC:

Papillary thyroid microcarcinoma

HT:

Hashimoto’s thyroiditis

ETE:

Extrathyroidal extension

mETE:

Microscopic extrathyroidal extension

LVI:

Lymphovascular invasion

LNM:

Lymph node metastasis

CLNM:

Central lymph node metastasis

LNs:

Lymph nodes

LNR:

Lymph node ratio

ENE:

Extranodal extension

References

  1. National Cancer Institute, Thyroid Cancer Treatment (Adult) (PDQ ®)– Health Professional Version. (2018) https://www.cancer.gov/types/thyroid/hp/thyroidtreatment-pdq#section/all, Accessed date: 1 May 2018.

  2. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid Cancer incidence and mortality in the United States, 1974–2013. JAMA. 2017;317(13):1338–48.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, et al. Indications and strategy for active surveillance of adult low-risk papillary thyroid Microcarcinoma: Consensus statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary thyroid Microcarcinoma. Thyroid. 2021;31(2):183–92.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas. Gland Surg. 2020;9(5):1663–73.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ito Y, Miyauchi A, Fujishima M, Noda T, Sano T, Sasaki T, et al. Thyroid-stimulating hormone, age, and tumor size are risk factors for progression during active surveillance of low-risk papillary thyroid microcarcinoma in adults. World J Surg. 2023;47:392–401.

    Article  PubMed  Google Scholar 

  6. Lee EK, Moon JH, Hwangbo Y, Ryu CH, Cho SW, Choi JY, et al. Progression of low-risk papillary thyroid microcarcinoma during active surveillance: interim analysis of a multicenter prospective cohort study of active surveillance on papillary thyroid microcarcinoma in Korea. Thyroid. 2022;32:1328–36.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Ward LS, Scheffel RS, Hoff AO, Ferraz C, Vaisman F. Treatment strategies for low-risk papillary thyroid carcinoma: a position statement from the thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM). Arch Endocrinol Metab 2022; 66:522– 32.8.

  8. Park YJ, Lee EK, Song YS, Kang SH, Koo BS, Kim SW, et al. 2023 Korean Thyroid Association management guidelines for patients with thyroid nodules. Int J Thyroidol. 2023;16:1–31.

    Article  Google Scholar 

  9. Zhang C, Li BJ, Liu Z, Wang LL, Cheng W. Predicting the factors associated with central lymph node metastasis in clinical node-negative (cN0) papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol. 2020;277(4):1191–8.

    Article  PubMed  Google Scholar 

  10. Kim BY, Choi N, Kim SW, Jeong HS, Chung MK, Son YI. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node-negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol. 2020;277(2):569–76.

    Article  PubMed  Google Scholar 

  11. Feng JW, Ye J, Wu WX, Qu Z, Qin AC, Jiang Y. Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence. J Endocrinol Invest. 2020;43(12):1807–17.

    Article  PubMed  Google Scholar 

  12. Lee J, Song Y, Soh EY. Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci. 2014;29(1):48–52.

    Article  PubMed  Google Scholar 

  13. Liu L, Liang J, Li J, Liu X, Jiang L, Long J, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol. 2017;274(3):1327–38.

    Article  PubMed  Google Scholar 

  14. Kim HI, Hyeon J, Park SY, Ahn HS, Kim K, Han JM, et al. Impact of Extranodal extension on risk stratification in papillary thyroid carcinoma. Thyroid. 2019;29(7):963–70.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Lang BH, Shek TW, Wan KY. Impact of microscopic extra-nodal extension (ENE) on locoregional recurrence following curative surgery for papillary thyroid carcinoma. J Surg Oncol. 2016;113(5):526–31.

    Article  PubMed  CAS  Google Scholar 

  16. Lin SY, Li MY, Zhou CP, Ao W, Huang WY, Wang SS, et al. Accurate preoperative prediction of nodal metastasis in papillary thyroid microcarcinoma: towards optimal management of patients. Head Neck. 2024;46(5):1009–19.

    Article  PubMed  Google Scholar 

  17. Qiu P, Guo Q, Pan K, Lin J. Development of a nomogram for prediction of central lymph node metastasis of papillary thyroid microcarcinoma. BMC Cancer. 2024;24(1):2352.

    Article  Google Scholar 

  18. Wang Y, Guan Q, Xiang J. Nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a retrospective cohort study of 8668 patients. Int J Surg. 2018;55:98–102.

    Article  PubMed  Google Scholar 

  19. Ma B, Wang Y, Yang S, Ji Q. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Surg. 2016;28:153–61.

    Article  PubMed  Google Scholar 

  20. Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF V600E mutation and recurrence of papillary thyroid cancer. J Clin Oncol. 2015;33(1):42–50.

    Article  PubMed  Google Scholar 

  21. Melo M, da Rocha AG, Vinagre J, et al. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2014;99(5):E754–65.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, et al. Thyroid carcinoma, Version 2.2022, NCCN Clinical Practice guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(8):925–51.

    Article  PubMed  CAS  Google Scholar 

  23. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid Cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid Cancer. Thyroid. 2016;26(1):1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Basolo F, Macerola E, Poma AM, Torregrossa L. The 5th edition of WHO classification of tumors of endocrine organs: changes in the diagnosis of follicular-derived thyroid carcinoma. Endocrine. 2023;80(3):470–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Kim E, Park JS, Son KR, Kim JH, Jeon SJ, Na DG. Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma: comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography. Thyroid. 2008;18(4):411–8.

    Article  PubMed  CAS  Google Scholar 

  26. Amin MB, Edge SB, Greene FL. AJCC cancer staging manual. 8th ed. Chicago, il: Springer; 2017.

    Google Scholar 

  27. Tuttle RM, Fagin JA, Minkowitz G, Wong RJ, Roman B, Patel S, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol Head Neck Surg. 2017;143:1015–20.

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Yunhe Liu and Lida Liao contributed equally to this work.

Authors and Affiliations

  1. Department of Head and Neck Surgical Oncology, National Cancer Centre, National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 10021, China

    Yunhe Liu, Lida Liao, Dangui Yan, Jie Liu, Wensheng Liu, Shaoyan Liu & Hui Huang

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Contributions

Yunhe Liu, Lida Liao and Hui Huang contributed to conception and design of the study. Yunhe Liu, Lida Liao organized the database and performed the statistical analysis. Yunhe Liu, Lida Liao wrote sections of the manuscript and prepared tables. Jie Liu, Wensheng Liu and Shaoyan Liu contributed to manuscript revision. All authors read and approved the submitted version.

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Correspondence to Hui Huang.

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The study was carried out in accordance with the guidelines and regulations for human research (Helsinki declaration). The study was approved by the Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences. Informed consent was obtained at the time of surgery for general use of clinical information for future studies.

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Liu, Y., Liao, L., Yan, D. et al. The impact of age at diagnosis on central lymph node metastasis in clinically low-risk papillary thyroid microcarcinoma patients. Thyroid Res 18, 6 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13044-025-00224-z

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Keywords

Thyroid Research

ISSN: 1756-6614