Establishing a Predictive Nomogram for Cervical Lymph Node Metastasis in Patients With Papillary Thyroid Carcinoma

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.

Accuracy of papillary thyroid cancer prognostic nomograms: a systematic review

“…Fifteen articles were excluded because they were repeated publication/overlapped samples ( n = 4), no surgical approach ( n = 3), outcomes different to those considered in the study ( n = 2), the nomograms were not reported ( n = 2), statistical model used to determine risk factors differed from logistic regression or Cox regression ( n = 2), nomograms used to evaluate the diagnostic accuracy of diffusion-weighted imaging ( n = 1), and a study related to micro PTC ( n = 1). Finally, 18 studies, for a total of 20 models, were included ( 10 , 19 , 20 , 29 , 35 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ). The studies included a total of 90,969 patients ( Table 1 ).…”

“…More than 50,000 patients were enrolled in the training set, 44,138 were used for validation of whom 3412 were in the external validation. Seventeen of the 19 studies were conducted in China ( 10 , 19 , 20 , 29 , 35 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 60 , 61 ), except for Kim's study, which was conducted in South Korea ( 54 ). Two studies began in 1997 and were completed in 2011 ( 49 ) and 2016 ( 54 ).…”

“…In the included studies, tumor size was reported with different classifications, from the simplest comparison between ≤ 1 cm vs. > 1 cm to more analytical (≤ 0.5 cm, 0.5-1.0 cm, 1.0-2.0 cm, 2.0-4.0 cm, > 4.0 cm), thus leading to higher heterogeneity. 72), whereas CLNM and LLNM incidence, although controversial, appears to be higher in younger patients (10,62,65,(73)(74)(75).…”

“…Differentiated thyroid cancer (DTC) accounts for 90% of all thyroid cancers and is increasing threefold every decade ( 1 ) so that by 2040 it will be the fourth most common malignancy in the group aged 20–49 years ( 2 ). Papillary thyroid carcinoma (PTC) occurs in 80–85% of patients with DTC ( 3 , 4 , 5 , 6 , 7 , 8 , 9 ) and is three times more common in women than in men ( 10 ). In most cases, it is an indolent tumor with indolent cancer, slow disease progression, excellent prognosis, and a 10-year survival rate of more than 90% ( 11 , 12 , 13 ).…”

Clinical Value of Ultrasonography and Serum Markers in Preoperative N Staging of Thyroid Cancer

“…In addition, Li et al [ 17 ] proposed that TgAb level was not a significant risk factor for LNM. Hu et al [ 50 ] proposed that there was no significant difference in the expression level of TSH, TPOAb, T3, T4, FT3, and FT4 between the pN0 and pN1 groups. The conclusions of this study are consistent with their findings.…”