Prediction mode of more than 5 central lymph nodes metastases in clinically node-negative ipsilateral papillary thyroid carcinoma with tumor size 1 to 4 cm

Abstract

According to the 2015 American Thyroid Association guidelines, either lobectomy or total thyroidectomy was recommended for patients with papillary thyroid carcinoma (PTC) of 1 to 4 cm without extrathyroidal extension and lymph node metastasis. However, lymph node metastases showed strong association with recurrence and low survival rate, especially in PTC patients with more than 5 metastatic lymph nodes. Therefore, this study aimed to investigate the predictive factors of more than 5 central lymph nodes metastases (CLNM) in PTC patients with tumor sizes of 1 to 4 cm. A total of 382 patients with clinically node-negative (cN0) ipsilateral PTC who underwent thyroidectomy with central neck dissection between January 2012 and December 2016 were retrospectively analyzed. CLNMs of >5 were found in 54 (14.1%) patients, while CLNM was detected in 230 (60.2%) patients. Multivariate logistic regression revealed age < 45 years ( P < .001), male gender ( P = .013), and tumor sizes of >2 cm ( P = .001) as independent predictive factors of >5 CLNMs in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm. The prediction equation (Y = 1.694 × age + 0.807 × gender + 1.190 × tumor size − 3.530) was developed, with a sensitivity (57.4%) and a specificity (80.8%), respectively, at an optimal cut-off point of −1.685. Therefore, if the predictive value was higher than −1.685 according to the equation in cN0 ipsilateral PTC patients with tumor sizes 1 to 4 cm, then total thyroidectomy might be considered.

Analysis of factors influencing the clinical outcome after surgery and 131I therapy in patients with moderate-risk thyroid papillary carcinoma

“…PTC recurrence was predicted by a tumor size of >4 cm (23). It has also been established by several studies that the greater the number of lymph node metastases, the worse the clinical outcome (24,25), and the local recurrence rate of DTC patients gradually increases with an increase in the number and diameter of lymph node metastases (26,27). In support, several researchers have reported that 131 I has a significant efficacy when the maximum diameter of the lymph node is <1 cm (28).…”

The impact of thyroid tumor features on lymph node metastasis in papillary thyroid carcinoma patients in head and neck department at KAMC: A retrospective cross-sectional study

“…There is a relationship between primary tumor features and the histopathological component of lymph node metastasis, which is linked to tumor invasiveness [ 10 ]. Male gender, age under 45, and absence of Hashimoto's thyroiditis are all risk factors for central lymph node metastasis (CLNM) [ 11 ]. Tumor characteristics such as multifocality, size, extrathyroidal extension, capsular invasion, and lymphovascular invasion are also risk factors for LNM [ 12 ].…”