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Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study
Jiantao Gong1, Baining Zhu1, Wenji Liu1
1Departement of Thyroid Surgery, Nanchang University Second Affiliated Hospital, Nanchang, China.
Hormone and Metabolic Research = Hormon- Und Stoffwechselforschung = Hormones Et Metabolisme
|March 19, 2023
Summary
Identifying risk factors for cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is crucial. This study found age, male sex, tumor size, and fasting plasma glucose predict LNM, aiding treatment decisions.
Area of Science:
- Oncology
- Endocrinology
- Surgical Pathology
Background:
- Cervical lymph node metastasis (LNM) is a critical prognostic factor in papillary thyroid carcinoma (PTC).
- Risk factors for LNM in PTC, particularly for tumors larger than 1 cm, remain incompletely understood.
- Accurate prediction of LNM is essential for tailoring treatment strategies and improving patient outcomes.
Purpose of the Study:
- To investigate the clinical risk factors associated with various types of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) patients with tumor diameter > 1 cm.
- To develop a predictive model for lateral LNM (LLNM) to guide prophylactic lymph node dissection decisions.
Main Methods:
- Retrospective analysis of clinical data from 2216 PTC patients.
- Application of univariate and multivariate logistic regression models to identify risk factors for LNM.
- Utilizing Receiver Operating Characteristic (ROC) curves to determine optimal cut-off values for predicting LLNM.
- Construction of a predictive nomogram for LLNM based on identified independent risk factors.
Main Results:
- Independent risk factors for central LNM (CLNM) included age ≤ 55 years, male sex, bilateral tumors, extrathyroidal extension (ETE), tumor diameter of 2-3 cm, and fasting plasma glucose (FPG).
- Age, male sex, bilateral tumors, tumor diameter ≥ 2 cm, and CLNM ≥ 3 were significantly associated with LLNM; CLNM of 1 or 2 was protective.
- Tumor diameter ≥ 3 cm was the only significant risk factor for skip LLNM.
- The developed nomogram demonstrated good predictive ability for LLNM (C-index = 0.745).
Conclusions:
- The study identified key clinical factors predicting CLNM and LLNM in PTC patients.
- A nomogram integrating these factors provides a valuable tool for predicting LLNM and guiding prophylactic lateral lymph node dissection in high-risk individuals.
- Prophylactic lymph node dissection is recommended for patients identified as high-risk based on these factors.
