Predictive Factor of Large‐Volume Central Lymph Node Metastasis in Clinical N0 Papillary Thyroid Carcinoma Patients Underwent Total Thyroidectomy

Abstract

Large‐volume central lymph node metastasis (large-volume CLNM) is associated with high recurrence rate in papillary thyroid carcinoma (PTC) patients. However, sensitivity in investigating large-volume CLNM on preoperative ultrasonography (US) is not high. The aim of this study is to investigate the clinical factors associated with large-volume CLNM in clinical N0 PTC patients. We reviewed 976 PTC patients undergoing total thyroidectomy with central lymph node dissection during 2017 to 2019. The rate of large-volume LNM was 4.1% (40 of 967 patients). Multivariate analysis showed that male gender and young age (age<45 years old) were independent risk factors for large-volume CLNM with odds ratios [(OR), 95% confidence interval (CI)] of 2.034 (1.015-4.073) and 2.997 (1.306–6.876), respectively. In papillary thyroid microcarcinoma (PTMC), capsule invasion was associated with large-volume CLNM with OR (95% CI) of 2.845 (1.110–7.288). In conventional papillary thyroid cancer (CPTC), tumor diameter (>2cm) was associated with large-volume CLNM, with OR (95% CI) 3.757 (1.061–13.310), by multivariate analysis. In ROC curve analysis on the diameter of the CPTC tumor, the Area Under Curve (AUC) =0.682(p=0.013), the best cut-off point was selected as 2.0cm. In conclusion, male gender and young age were predictors for large-volume CLNM of cN0 PTC. cN0 PTMC patient with capsule invasion and cN0 CPTC patient with tumor diameter >2cm were correlated with large-volume CLNM. Total thyroidectomy with central lymph node dissection may be a favorable primary treatment option for those patients.

Predictors and a Prediction Model for Central Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma (cN0)

“…Age is important for PTC staging. Traditionally, patients over 45 years of age have a slightly worse prognosis and an increased recurrence rate ( 13 , 14 ). Some studies have also shown that age is a risk factor for central CLNM.…”

Clinical and ultrasonic risk factors for high‐volume central lymph node metastasis in cN0 papillary thyroid microcarcinoma: A retrospective study and meta‐analysis

“…These are consistent with the conclusion from the analysis of the relationship between tumour size and LNM in our meta‐analysis. However, among the included 11 articles, only three (including our data) supported that tumour diameter greater than 0.5 cm was an independent factor affecting hv‐CLNM, 35,40 while five studies did not 31,32,34,36,37 . Combined with the findings of our meta‐analysis, we believe that the results of these five studies were influenced by a small number of positive cases.…”

“…Subsequently, the full text was carefully read and three papers on the analysis of PTC were excluded as PTMC subgroup analysis was not performed; one of these did not provide the available data and was excluded. Finally, 11 studies that met the inclusion criteria comprising 14,002 patients (including our data) were included in the meta‐analysis 31–40 . The incidence of hv‐CLNM in the literature ranged from 3.4% to 9.5%.…”

Artificial Neural Network-Based Ultrasound Radiomics Can Predict Large-Volume Lymph Node Metastasis in Clinical N0 Papillary Thyroid Carcinoma Patients

“…Age is the most important prognostic factor for thyroid carcinoma [9]. Large-volume LNM is more likely to appear in PTMC patients aged <40 years [10,11].…”

“…Previous studies reported that age (<40 years old) and male sex were significantly associated with large-volume LNM in PTC patients [9][10][11]. Nevertheless, these studies focused on identifying risk factors for large-volume LNM rather than constructing a predictive model.…”