Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma

Abstract

With the increasing incidence of papillary thyroid cancer (PTC), it is important to risk-stratify patients who may have a more aggressive tumor biology. The present study aimed to evaluate the risk factors for lymph node metastasis (LNM) in patients with PTC, which may provide a significant reference for clinical diagnosis and treatment. In total, 1,045 patients with PTC [313 with PT microcarcinoma (PTMC) and 732 with non-PTMC] between August 2016 and August 2019 were investigated. The B-type Raf kinase (BRAF) V600E mutation was tested in all samples. The clinical data (sex, age, tumor location, sample type and pathological features) were retrospectively analyzed. Logistic regression analysis was performed to evaluate independent risk factors for LNM. A total of 181/313 (57.8%) PTMC cases and 145/732 (19.8%) non-PTMC cases had a BRAF V600E mutation. In the PTMC cases, significant differences in sex and sample type were identified (BRAF V600E mutation vs. wild-type). In the non-PTMC cases, significant differences in sex and age were identified (BRAF V600E mutation vs. wild-type). Female sex and tumor diameter ≤1 cm were significant independent predictors of LNM in PTC. In PTMC, female sex was a significant independent predictor of LNM. A bilateral tumor was an independent protective factor for LNM in PTC, PTMC and non-PTMC. The BRAF V600E mutation rate of ultrasound-guided fine-needle aspiration cytology was higher compared with FFPE in PTMC (P=0.018). In contrast to previous studies, the results of the present study suggested that being female and having a tumor of diameter ≤1 cm were risk factors for LNM, and that the BRAF wild-type of PTMC may be more aggressive than other types. Notably, the position of the tumor in the bilateral thyroid was also an independent protective factor for LNM. Therefore, ultrasound-guided fine-needle aspiration should be recommended for gene analysis (BRAF V600E) in PTMC. In addition, clinicians should consider an individualized treatment according to gene mutations, sex, age, tumor size and the location of the tumor, in order to achieve an improved therapeutic efficacy.

Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

“…Multivariate Cox regression analysis in this study found that older age, larger tumor size, upper pole location, and capsular invasion were independent factors of the SLNM development. Older age is a risk factor for both PTC [17][18][19] and LLNM. 20,21 Wang et al concluded that age ≥55 years was an independent risk factor for SLNM, which is consistent with the findings of this study.…”

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

“…Thyroid cancer is the most frequently occurring endocrine cancer in China and has the fastest increase in incidence [ 1 , 2 ]. At present, surgery is the essential method of curing thyroid cancer, especially papillary thyroid carcinoma, which is the most common pathological type [ 3 , 4 ].…”