ArticleThe oncologist2026
ATA 2015-2025 risk stratification transition: prognostic significance of N1b disease in papillary thyroid carcinoma with limited nodal burden.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe ATA risk stratification system has evolved from the 2015 framework toward a more composite nodal risk assessment in the 2025 update. Whether low-volume lateral neck disease remains clinically meaningful is uncertain. We evaluated the prognostic significance of N1b vs N1a disease in papillary thyroid carcinoma (PTC) with ≤5 metastatic lymph nodes. MATERIALS AND
methodsWe identified 11 878 patients with PTC and N1a or N1b disease with ≤5 metastatic lymph nodes from the SEER database (2000-2022). One-to-one propensity score matching was performed. OS and CSS were assessed using Kaplan-Meier analysis, and CSD and OCD using cumulative incidence functions and Fine-Gray models.
resultsAmong eligible patients, 9392 had N1a disease and 2486 had N1b disease. After matching, 2467 patients remained in each group. N1b was associated with significantly worse OS, CSS, and CSD in both unmatched and matched cohorts. In the matched cohort, 5-year CSD increased from 1.5% to 2.8%. On multivariable Fine-Gray analysis, N1b remained independently associated with higher CSD risk (SHR, 2.52; 95% CI, 1.85-3.43; P < .001). The adverse effect was more evident in patients with positive ETE, tumor diameter >2 cm, and older age.
conclusionAmong patients with PTC and ≤5 metastatic lymph nodes, N1b retains independent adverse prognostic significance despite low nodal burden. Low-volume nodal disease should not be considered uniformly low risk when lateral neck involvement is present, particularly in patients with positive ETE, tumor diameter >2 cm, or older age.
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