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Published on: June 9, 2023
Predictive risk-scoring model for lateral lymph node metastasis in papillary thyroid carcinoma.
Yehao Guo1,2, Yunye Liu1, Weidong Teng1,3
1Otolaryngology and Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
This study identifies key risk factors for lateral lymph node metastasis in papillary thyroid carcinoma (PTC) and develops a predictive scoring model. The model aids in stratifying PTC patients for targeted treatment and follow-up, improving patient outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Endocrine Surgery
Background:
- Papillary thyroid carcinoma (PTC) recurrence and metastasis significantly impact patient prognosis.
- Accurate identification of patients at high risk for lateral lymph node metastasis (LLNM) is crucial for effective treatment planning.
- Existing models may not fully capture the complexity of LLNM predictors in PTC.
Purpose of the Study:
- To evaluate candidate risk factors for LLNM in PTC patients.
- To develop and validate a predictive scoring model for stratifying LLNM risk.
- To identify risk factors for recurrence to guide postoperative management and follow-up strategies.
Main Methods:
- Retrospective analysis of 4107 PTC patients who underwent lymph node dissection (2005-2014).
- Multivariate analysis to identify independent predictors of LLNM.
- Development of a 12-point risk-scoring model for LLNM prediction.
- Cox's proportional hazards regression to assess recurrence risk factors.
Main Results:
- LLNM was observed in 10.49% of patients.
- Independent predictors for LLNM included age ≤ 35 years, tumor size > 1.0 cm, lobe dissemination, and central lymph node metastasis (CLNM).
- The developed risk-scoring model demonstrated good predictive performance (AUROC = 0.794).
- Tumor size > 1.0 cm, lobe dissemination, multifocality, CLNM, and LLNM were significant risk factors for poor outcomes.
Conclusions:
- A validated risk-scoring model can effectively stratify PTC patients based on LLNM risk.
- Patients with a score > 5 warrant closer investigation and consideration for prophylactic dissection.
- Identifying high-risk factors like tumor size, lobe dissemination, multifocality, and CLNM guides aggressive treatment and tailored follow-up for improved PTC management.
