Predictive Risk-scoring Model For Central Lymph Node Metastasis and Predictors of Recurrence in Papillary Thyroid Carcinoma

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.

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

“…Multivariate analysis shows age < 45 years was independent predictor of largevolume CLNM inpatients with cN0 PTC. Similarly, previous studies have reported that CLNM was more likely to appear in PTC patients with age < 45 years, which may be due to rapid tumor diameter growth in young patient during surveillance period (6,14,15). These results indicate that much careful preoperative assessment of the lymph node status must be followed in young patients.…”

Lymph node metastasis of papillary thyroid carcinoma in the context of Hashimoto’s thyroiditis

“…In general, different inclusion criteria may have an impact on the results. Previous studies have reported that young age is a risk factor for PTC LNM, while female sex is a protective factor [26,27]. In our study, most patients in the HT group were younger females; thus, risk and protective factors were mixed.…”

“…The independent risk factors for central LNM in the HT group were age < 55 and tumor size ≥10 mm, in the non-HT group were male sex and tumor size ≥10 mm. Male sex is an independent risk factor for PTC central LNM in other studies [8,[26][27][28]. However, this association disappeared in HT PTCs.…”

A Nomogram Based on Clinical and Ultrasound Characteristics to Predict Central Lymph Node Metastasis of Papillary Thyroid Carcinoma

“…The records of patients with PTC who underwent surgery from July 2019 to June 2020 at the Department of Thyroid Surgery of Changzhou First People's Hospital were retrospectively reviewed. Patients were excluded from the study if they have any of the following factors: (1) non-PTCs (medullary/follicular/ anaplastic) or other subtypes than classic PTC (such as mixed PTC and so on); (2) patients who underwent non-curable surgery or did not undergo CND; (3) patients with another malignancy before thyroidectomy; (4) patients with previous thyroid operation; (5) distant metastasis at diagnosis on pathological or clinical analysis; (6) history of neck radiation or familial cancer; (7) incomplete clinical data or missing follow-up. According to above criteria, 886 patients with PTC were enrolled in this study.…”

“…As reported, the risk of lymph node metastasis (LNM) in the central neck compartment was the highest, ranging from 18% to 80% ( 2 – 4 ). Some studies reported that central lymph node metastasis (CLNM) was even associated with an increased risk of regional recurrence ( 5 , 6 ).…”