Clinical analysis of risk factors for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and preventive dissection

Abstract

Objective To discuss the clinical characteristics for central compartment lymph node metastasis in stage cNO papillary thyroid microcarcinoma and significance and feasibility of preventive dissection, aimed to provide reference for clinical treatment. Methods Reviewed the clinical data of 277 patients with stage cN0 papillary thyroid microcarcinoma from Jul. 2011 to Dec. 2015 underwent surgery in the Department of General Surgery of Lianyungang East Hospital. Evaluated the necessity of prophylactic central lymph node dissection. Adopted chi square test and Logistic regression to analyze its relationship with patients′ gender, age, tumor number, tumor size, enveloped infiltration, single and bilateral tumor. All 277 patients underwent primary radical resection with ipsilateral central lymph node dissection. The specimen of resection was analyzed by routine pathology. Results The positive rate of thyroid papillary microcarcinoma lymph node metastasis was 36.8% (102/277). The elements of male patients (P=0.023), age 0.5 cm (P=0.019) had high positive rate. The multivariable analysis showed that male patients (OR=2.63, P 0.5 cm (OR=2.13, P=0.009) were independent risk factors for CLN metastasis.Forty-three (15.5%) cases had transient parathyroid function. No Permanent recurrent nerve paralysis and hyperparathyroidism occurred in this group. Conclusions Prophylactic central lymph node dissection is helpful for accurate staging of tumor classification and risk assessment, has important significance, on the follow-up of patients after treatment of choice. For male patients, age 0.5 cm, enveloped infiltration, the central compartment lymph node dissection may be necessary. Key words: Papillary thyroid carcinoma; Prophylactic lymph node cleaning; Lymphatic metastasis; Chi-square distribution; Neck dissection