Risk nomogram for papillary thyroid microcarcinoma with central lymph node metastasis and postoperative thyroid...

Area of Science:

• Oncology
• Endocrinology
• Surgical Oncology

Background:

• The treatment for papillary thyroid microcarcinoma (PTMC) remains controversial.
• Accurate preoperative identification of central lymph node metastasis (CLNM) is crucial for PTMC management.
• CLNM is a key predictor of recurrence and survival in PTMC.

Purpose of the Study:

• To develop and validate a nomogram for predicting the likelihood of CLNM in PTMC patients.
• To identify significant risk factors associated with CLNM in PTMC.
• To provide a tool for optimizing surgical protocols in PTMC.

Main Methods:

• A retrospective analysis of 3023 PTMC patients, divided into training (n=2116) and validation (n=907) groups.
• Utilized LASSO and multivariate logistic regression to identify risk factors for CLNM.
• Constructed and internally validated a nomogram, with a 4-year follow-up of thyroid function in a subset of patients.

Main Results:

• Key predictors of CLNM included younger age, lower BMI, male sex, lower pole location, calcification, tumor size (0.5-1 cm), multifocality, ETE, ECLN, LLNM, and elevated CEA.
• The nomogram achieved AUCs of 0.73 (training) and 0.75 (validation).
• Postoperative thyroid function (FT3, FT4) was stable after 3 months, higher in the CLNM (+) group, with hypothyroidism more prevalent within 3 months.

Conclusions:

• The developed nomogram demonstrates good predictive performance for CLNM in PTMC.
• This tool offers a valuable reference for clinical decision-making and surgical planning in PTMC management.
• The findings support the utility of the nomogram in guiding intervention strategies for PTMC patients.