Abstract
There are about half of papillary thyroid carcinoma (PTC) patients with the experience of central lymph node metastasis (CLNM), while the model to predict high-risk groups of CLNM from PTC patients is uncertain. The aim of this study was to evaluate candidate risk factors of CLNM and identify risk factors of recurrence to guide the postoperative therapeutic decision and follow-up for physicians and patients.A total of 4107 patients(4884 lesions) who underwent lymph node dissection in two hospitals from 2005 to 2014 were evaluated. CLNM risk was stratified and a risk-scoring model was developed on the basis of the identified independent risk factors for CLNM. Cox’s proportional hazards regression model was used to investigate the risk factors for recurrence.CLNM was proved in 37.96% (1559/4107) of patients and 33.96% (1659/4884) of lesions. In the multivariate analysis, Male, Age ≤35 years, Tumor size >0.5 cm,Lobe dissemination (+), Psammoma body (+), Multifocality and Capsule invasion (+) were independent risk predictors of CLNM (P < 0.01). A 14-point risk-scoring model was built to predict the stratified CLNM in PTC patients and the area under receiver operating characteristic curve of the model for the prediction of CLNM was 0.672 (95% CI: 0.656–0.688) (P < 0.01). COX regression model showed that Tumor size >0.5 cm, Lobe dissemination (+), Multifocality and CLNM were significant risk factors associated with poor outcomes. The research suggested that prophylactic CLN dissection could be performed in patients with total score ≥4 according to the risk-scoring model, and more aggressive treatment and more frequent follow-up should be considered for patients with Tumor size >0.5 cm, Lobe dissemination (+), Multifocality and CLNM.
Highlights
In current years, the global prevalence of thyroid cancer has increased swiftly
Gender, Age, Tumor size, Lobe dissemination, Psammoma body, Tumor number and Capsule invasion were significantly associated with central lymph node metastasis (CLNM) (P < 0.05), while no significant correlation was found between Bilateral and CLNM (P > 0.05) (Table 1)
Male (P < 0.01, odds ratio 1.706, 95% CI 1.469–1.981), Age ≤35 years (P < 0.01, odds ratio 2.217, 95% CI 1.893–2.597), Tumor size >0.5 cm (P < 0.01, odds ratio 3.154, 95% CI 2.706–3.676), Lobe dissemination (+) (P < 0.01, odds ratio 3.027, 95% CI 2.333–3.928), Psammoma body (+) (P < 0.01, odds ratio 3.158, 95% CI 1.943–5.132), Multifocality (P < 0.01, odds ratio 1.542, 95% CI 1.321–1.800) and Capsule invasion (+) (P < 0.01, odds ratio 1.508, 95% CI 1.316–1.728) were independent risk predictors of CLNM (Table 2)
Summary
The global prevalence of thyroid cancer has increased swiftly. In 2012, thyroid cancer even has exceeded breast carcinoma as the most prevalent carcinoma of women in Hangzhou, China[1]. Even in the clinical lymph node negative patients, the rate of cervical lymph node metastasis ranges from 20–50% in different studies[5,6]. Due to the limitation of clinical examinations, it is hard to find subclinical lymph node metastasis in PTC patients, which may cause incomplete clinical treatment and seriously threaten the health of the patients. It has become increasingly important for us to discover appropriate clinical and pathological predictors of lymph node metastasis to guide treatment decisions. We gathered data on prognosis in order to recognize risk factors of recurrence, which may offer guidance on the postoperative therapeutic decision and follow-up for physicians and patients
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