Development and validation of a nomogram for preoperative prediction of cervical lymph node involvement in thyroid microcarcinoma.

Si Lu,Jingjing Shi,Jinwang Ding,Gang Pan,Yu Zhang,Dingcun Luo,Rongjie Zhao,Fuqiang Qiu,Fan Wu,Yeqin Ni,Tianhan Zhou,You Peng

doi:10.18632/aging.102915

Abstract

Cervical regional lymph node involvement (CRLNI) is common in papillary thyroid microcarcinoma (PTMC), but the way to deal with cervical lymph node involvement of clinically negative PTMC is controversial. We studied data of patients histologically confirmed PTMC in the Surveillance, Epidemiology, and End Results (SEER) Program and Department of Surgical Oncology in Hangzhou First People’s Hospital (China). We screened 6 variables of demographic and clinicopathological characteristics as potential predictors and further constructed a lymph node involvement model based on the independent predictors including age, race, sex, extension, multifocality and tumor size. The model was validated by both the internal and the external testing sets, and the visual expression of the model was displayed by a nomogram. As a result, the C-index of this predictive model in the training set was 0.766, and the internal and external testing sets through cross-validation were 0.753 and 0.668, respectively. The area under the receiver operating characteristic curve (AUC) was 0.766 for the training set. We also performed a Decision Curve Analysis (DCA), which showed that predicting the cervical lymph node involvement risk applying this nomogram would be better than having all patients or none patients use this nomogram.

Highlights

Papillary thyroid carcinoma (PTC) is the most common malignancy in thyroid cancer
The guidelines from some countries underline positively the necessity of prophylactic central neck dissection (pCND) for cN0 papillary thyroid microcarcinoma (PTMC) patients, such as China and Japan, for previous studies had found that a large number of pathological lymph nodes positive patients were detected after lymph node dissection in PTMC patients with cN0 [7, 8]
All data were divided into three groups which consisted of the training set (n=15124, 70% of SEER), internal testing set (n=6482, 30% of SEER) and external testing set

Summary

Introduction

Papillary thyroid carcinoma (PTC) is the most common malignancy in thyroid cancer. In the past decades, the incidence of PTC has increased rapidly, with a range from 2.9 to 3.2-fold increase [1, 2]. Thyroidectomy combines with therapeutic lymph node dissection has become a common initial surgical strategy for PTMC patients with clinical lymph nodes positive(cN1). The www.aging-us.com significance of prophylactic central neck dissection (pCND) in clinical lymph nodes negative(cN0) PTMC patients remains controversial. The guidelines from some countries underline positively the necessity of pCND for cN0 PTMC patients, such as China and Japan, for previous studies had found that a large number of pathological lymph nodes positive (pN1) patients were detected after lymph node dissection in PTMC patients with cN0 [7, 8]. A lot of studies have been done on the risk factors affecting CRLNI in PTMC, but papers constructing risk models to predict CRLNI are very limited, which may be used to guide clinical decisions in the future

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