Abstract
The health problems caused by the frequent relapse of papillary thyroid carcinoma (PTC) remain a worldwide concern since the morbidity rate of PTC ranks the highest among thyroid cancers. Residues from contralateral central lymph node metastases (con-CLNM) are the key reason for persistence or recurrence of unilateral papillary thyroid carcinoma (uni-PTC); however, the ability to assess the status of con-CLNM in uni-PTC patients is limited. To clarify the risk factors of con-CLNM, a total of 250 patients with uni-PTC who underwent total thyroidectomy and bilateral central lymph node dissection were recruited in this study. We compared the clinical, sonographic, and pathological characteristics of patients with con-CLNM to those without con-CLNM and established a nomogram for con-CLNM in uni-PTC. We found that male sex, without Hashimoto's thyroiditis, present capsular invasion, with ipsilateral lateral lymph node metastases, and the ratio of ipsilateral central lymph node metastases ≥0.16 were independent con-CLNM predictors of uni-PTC (ORs: 2.797, 0.430, 2.538, 2.202, and 26.588; 95% CIs: 1.182–6.617, 0.211–0.876, 1.223–5.267, 1.064–4.557, and 7.596–93.069, respectively). Additionally, a preoperative nomogram for the prediction of con-CLNM based on these risk factors showed good discrimination (C-index 0.881; 95% CI: 0.840–0.923; sensitivity 85.3%; specificity 76.0%) and good agreement via the calibration plot. Our study provided a way to quantitatively and accurately predict whether con-CLNM occurred in patients with uni-PTC, which may guide surgeons to evaluate the nodal status and perform tailored therapeutic central lymph node dissection.
Highlights
Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer, with an incidence increasing dramatically worldwide [1,2,3]
A stepwise fashion has been widely accepted for cervical lymph node metastasis of PTC, which means primary tumor cells of the PTC initially spread from the thyroid gland to the ipsilateral central compartment and subsequently to the lateral compartment on the same side followed by the contralateral central compartment, lateral compartment, and mediastinal lymph nodes [9,10,11,12]; when cervical lymph node metastases are detected by either clinical or radiological means, ipsilateral central lymph node dissection (CLND) in unilateral papillary thyroid carcinoma is well accepted [13, 14]
Clinical N0 was defined as patients without clinical evidence of any lymph node metastases on preoperative or intraoperative examination, and clinical N1 was defined as patients with clinically evident lymph nodes based on preoperative physical examination, preoperative imaging evaluation, or intraoperative evidence of detectable lymph nodes according to the American yroid Association (ATA, 2015 Edition) [20]. erapeutic CLND was performed when suspicious central LN metastasis was discovered during preoperative or intraoperative examination, and prophylactic CLND was performed for these advanced PTC patients (T3/T4) or clinically involved lateral neck lymph nodes; or this information is helpful for follow-up therapy [20]
Summary
Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid cancer, with an incidence increasing dramatically worldwide [1,2,3]. Cervical lymph node metastasis (LNM), which occurs in approximately 20–90% of PTC patients, makes regional recurrence an important issue [6, 7]. Central lymph node metastasis (CLNM) is an important prevalent factor affecting cancer recurrence in PTC patients [8]. Approximately 20%–25% uni-PTC with pathological positive ipsilateral CLNM (ipsi-CLNM) were found
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