Abstract
Background and PurposeCentral compartment lymph node metastasis (CLNM) is a manifestation of tumor aggressiveness and an indicator of tumor prognosis. The purpose of this study was to construct a nomogram for evaluating CLNM patterns in papillary thyroid carcinoma (PTC) in different age groups.MethodA total of 907 patients diagnosed with PTC from August 2014 to December 2018 were enrolled. A nomogram illustrating CLNM was generated using the results of multivariate logistic regression analysis.ResultsAccording to the best Youden index, we set the cut-off age at 45 years. Multivariate logistic regression analysis showed that in patients aged <45 years, large tumor size (P<0.05), extra-thyroid extension (P<0.05) and thyroglobulin level >40 ng/ml (OR=2.985, 95% CI 1.379-6.462; P<0.05) were independent risk factors; meanwhile, Hashimoto’s thyroiditis (OR=0.532, 95% CI 0.324-0.874; P<0.05) was a protective factor of CLNM. In the subgroup with age ≥45 years, large tumor size (P<0.05), extra-thyroid extension (P<0.05), unclear margin (OR=1.604, 95% CI 1.065-2.416; P<0.05), male gender (OR=2.009, 95% CI 1.257-3.212; P<0.05) were independent risk factors for CLNM. In the subgroup with age <45 years, an area under the curve (AUC) of 0.729 (95% CI 0.680-0.777); P<0.05) was obtained. In the ≥45 years subgroup, the AUC was 0.668 (95% CI 0.619-0.716; P<0.05).ConclusionCLNM of PTC in different age groups may have distinct patterns. Based on the potential risk factors for CLNM in patients with different age stratification, a user-friendly predictive model was established.
Highlights
Background and PurposeCentral compartment lymph node metastasis (CLNM) is a manifestation of tumor aggressiveness and an indicator of tumor prognosis
The effects of extrathyroidal extension and tumor size in CLNM are reflected in all age groups
Males were more likely to have CLNM. These differences may be explained by different hormone levels and immune states in patients of different ages, which may inform decision-making for individual patients in the clinic
Summary
Central compartment lymph node metastasis (CLNM) is a manifestation of tumor aggressiveness and an indicator of tumor prognosis. The purpose of this study was to construct a nomogram for evaluating CLNM patterns in papillary thyroid carcinoma (PTC) in different age groups. Studies have shown that papillary thyroid carcinoma (PTC) has high rates of central compartment lymph nodes metastasis (CLNM), ranging from 20% to 90% [3]. Due to the use of nerve monitoring and carbon nanoparticle negative imaging [7, 8], permanent damage to the recurrent laryngeal nerve and parathyroid gland is rarely found during dissection of the initial central compartment lymph nodes. Because PTC has a good postoperative survival time, more attention is paid to the probability of postoperative recurrence. when PTC is recurrent and reoperated, it is more likely to cause permanent damage to the recurrent laryngeal nerve and parathyroid gland due to changes in anatomical structure
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