Abstract
ObjectivesThe purpose of this study was to establish a nomogram for predicting cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).Materials and MethodsA total of 418 patients with papillary thyroid carcinoma undergoing total thyroidectomy with cervical lymph node dissection were enrolled in the retrospective study from January 2016 to September 2019. Univariate and multivariate Logistic regression analysis were performed to screen the clinicopathologic, laboratory and ultrasound (US) parameters influencing cervical lymph nodes metastasis and develop the predicting model.ResultsCLNM was proved in 34.4% (144/418) of patients. In the multivariate regression analysis, Male, Age < 45 years, Tumor size > 20mm, multifocality, ambiguous boundary, extracapsular invasion and US-suggested lymph nodes metastasis were independent risk factors of CLNM (p < 0.05). Prediction nomogram showed an excellent discriminative ability, with a C-index of 0.940 (95% confidence interval [CI], 0.888-0.991), and a good calibration.ConclusionThe established nomogram showed a good prediction of CLNM in patients with PTC. It is conveniently used and should be considered in the determination of surgical procedures.
Highlights
Papillary thyroid carcinoma (PTC) originates from the thyroid follicular epithelium and is the major pathological type among thyroid malignancies, accounting for approximately 80% of all thyroid cancers [1]
Out of 418 patients, postoperative pathological results showed that 144 patients (144/418, 34.4%) had positive cervical lymph node metastasis (CLNM), of whom 99 cases had central lymph node metastasis, 28 cases had central and lateral lymph node metastasis, and 17 cases had skip metastasis of LLNM; 274 cases (274/418, 65.6%) were negative for CLNM
There was no significant difference in the expression level of thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb), T3, T4, FT3, FT4, CK-19, and CK-34, tumor internal components, and the presence or absence of thyroiditis between the CLNM-positive group and the CLNMnegative group (P > 0.1) (Table 2)
Summary
Papillary thyroid carcinoma (PTC) originates from the thyroid follicular epithelium and is the major pathological type among thyroid malignancies, accounting for approximately 80% of all thyroid cancers [1]. PTC is considered to be an indolent tumor with low malignancy, slow disease progression, and good prognosis [2], 20–50% of patients still have early cervical lymph node metastasis (CLNM), leading to a high risk of local recurrence [3]. Nomogram for CLNM in Patients With PTC. CLNM of PTC usually manifests as sequential lymph node metastasis from the central area to the lateral cervical area [4]. Some PTCs may undergo direct lateral lymph node metastasis (LLNM) without central lymph node metastasis, which is called “skip metastasis” [5]. CLNM is the strongest risk factor for local recurrence and the prognosis of PTC patients and is an important indicator for determining the surgical approach before surgery [6]
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