Clinicopathological Predictors of Cervical Lymph Node Metastasis and Recurrence in Patients Undergoing Surgical Management of Thyroid in Head and Neck Malignancies

Abstract

Background: Cervical lymph node metastasis is a major prognostic factor in thyroid and head and neck malignancies and is associated with increased recurrence and reduced survival.

Objective: To evaluate clinicopathological predictors of cervical lymph node metastasis and disease recurrence among patients undergoing surgical management for thyroid and head and neck malignancies.

Methodology: This retrospective cohort study was conducted at Department of ENT, Bolan Medical Complex Hospital Quetta from 1^st October 2024 to 31^st March 2025 and 210 patients with histopathologically confirmed thyroid or head and neck malignancies who underwent surgery with curative intent were included.

Results: The mean age of patients was 51.6±13.8 years with 126 (60%) were males. Cervical lymph node metastasis was identified in 97 (46.2%) patients and was significantly associated with younger age (48.2±12.9 vs. 54.5±14.1 years; p=0.001), larger tumor size (3.9±1.6 vs. 2.6±1.2 cm; p<0.001), advanced T stage, multifocality, lymphovascular invasion, perineural invasion, and extrathyroidal or extracapsular extension. Disease recurrence occurred in 42 (20%) patients and was significantly associated with cervical lymph node metastasis, positive surgical margins, larger tumor size, lymphovascular invasion, extrathyroidal or extracapsular extension, and advanced T stage. Multivariable analysis demonstrated that lymphovascular invasion (AOR=3.67, 95% CI: 1.89-7.11; p<0.001), tumor size >3 cm (AOR=2.84, 95% CI: 1.51-5.34; p=0.001), multifocality (AOR=2.21, 95% CI: 1.12-4.35; p=0.022), and extrathyroidal or extracapsular extension (AOR=2.95, 95% CI: 1.47-5.90; p=0.002) independently predicted cervical lymph node metastasis.

Conclusion: Clinicopathological features, including tumor size, multifocality, lymphovascular invasion, extrathyroidal or extracapsular extension, positive margins, and cervical lymph node metastasis, are significant predictors of recurrence in thyroid and head and neck malignancies.