Abstract
BackgroundSkip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients.Patients and methodsA total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated.ResultsThe incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342–5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017–1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710–17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736–0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful.ConclusionBased on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.
Highlights
The worldwide incidence of papillary thyroid carcinoma (PTC) has been steadily increasing in recent years [1]
Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342–5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017–1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710–17.060; P < 0.001) were found to be independent risk factors for skip metastasis in papillary thyroid cancer (PTC) patients
A nomogram based upon these predictors performed well
Summary
The worldwide incidence of papillary thyroid carcinoma (PTC) has been steadily increasing in recent years [1]. PTC often disseminates into cervical lymph nodes with a reported incidence from 30 to 80% at the first diagnosis [4, 5]. Cervical lymph node metastasis (LNM) is an important factor affecting local recurrence of PTC and long-term survival of patients [6, 7]. The significance of skip metastasis in patients with PTC is still unclear; if untreated, the risk will increase for locoregional recurrence and distant metastasis. Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients
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