Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients

Medas, Fabio; Canu, Gian Luigi; Cappellacci, Federico; Anedda, Giacomo; Conzo, Giovanni; Erdas, Enrico; Calò, Pietro Giorgio

doi:10.3390/cancers12061658

Cited by 32 publications

(39 citation statements)

References 36 publications

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“…PTC is currently considered to be a low-risk malignancy with a good prognosis worldwide; however, CLNM and postoperative recurrence can reduce the disease-free survival (DFS) in patients with PTC [ 21 , 32 , 33 ]. Studies have confirmed that there are 20%–25% probabilities that PTC can occur with con-CLNM [ 15 , 17 ]; bilateral CLND in advanced PTC has shown an improved DFS rate and reduced risk of recurrence [ 34 , 35 ], though controversy exists in whether contralateral prophylactic CLND should be carried out in uni-PTC and advanced PTC [ 13 , 14 ]. The incidence of residual nodal metastases in the contralateral central neck compartment was 14.3%–23.0% in PTC patients who underwent ipsilateral CLND, which was significantly higher than in those who underwent bilateral CLND [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer

Tan

Huang

et al. 2021

International Journal of Endocrinology

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The health problems caused by the frequent relapse of papillary thyroid carcinoma (PTC) remain a worldwide concern since the morbidity rate of PTC ranks the highest among thyroid cancers. Residues from contralateral central lymph node metastases (con-CLNM) are the key reason for persistence or recurrence of unilateral papillary thyroid carcinoma (uni-PTC); however, the ability to assess the status of con-CLNM in uni-PTC patients is limited. To clarify the risk factors of con-CLNM, a total of 250 patients with uni-PTC who underwent total thyroidectomy and bilateral central lymph node dissection were recruited in this study. We compared the clinical, sonographic, and pathological characteristics of patients with con-CLNM to those without con-CLNM and established a nomogram for con-CLNM in uni-PTC. We found that male sex, without Hashimoto’s thyroiditis, present capsular invasion, with ipsilateral lateral lymph node metastases, and the ratio of ipsilateral central lymph node metastases ≥0.16 were independent con-CLNM predictors of uni-PTC (ORs: 2.797, 0.430, 2.538, 2.202, and 26.588; 95% CIs: 1.182–6.617, 0.211–0.876, 1.223–5.267, 1.064–4.557, and 7.596–93.069, respectively). Additionally, a preoperative nomogram for the prediction of con-CLNM based on these risk factors showed good discrimination (C-index 0.881; 95% CI: 0.840–0.923; sensitivity 85.3%; specificity 76.0%) and good agreement via the calibration plot. Our study provided a way to quantitatively and accurately predict whether con-CLNM occurred in patients with uni-PTC, which may guide surgeons to evaluate the nodal status and perform tailored therapeutic central lymph node dissection.

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Section: Discussionmentioning

confidence: 99%

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer

Tan

Huang

et al. 2021

International Journal of Endocrinology

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“…The clinical community has reached a general consensus that central lymph node dissection (CLND) for therapeutic purposes is appropriate in PTC patients with suspected cervical lymph node metastasis (LNM) (5). By contrast, however, there is a growing controversy over the role of prophylactic central lymph node dissection (pCLND) due to the lack of randomized controlled data (6)(7)(8). Generally speaking, pCLND is not recommended for a subset of patients with small (T1 or T2), non-invasive, clinically node-negative (cN0) PTC according to the 2015 American Thyroid Association (ATA) guidelines (9), whereas the Japanese Society of Thyroid Surgery and the Chinese Thyroid Association both strongly recommend routine pCLND for cN0 PTC patients in order to stage disease and prevent recurrence.…”

Section: Introductionmentioning

confidence: 99%

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma

Zhu

Zheng

et al. 2021

Front. Med.

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Purpose: While there are no clear indications of whether central lymph node dissection is necessary in patients with T1-T2, non-invasive, clinically uninvolved central neck lymph nodes papillary thyroid carcinoma (PTC), this study seeks to develop and validate models for predicting the risk of central lymph node metastasis (CLNM) in these patients based on machine learning algorithms.Methods: This is a retrospective study comprising 1,271 patients with T1-T2 stage, non-invasive, and clinically node negative (cN0) PTC who underwent surgery at the Department of Endocrine and Breast Surgery of The First Affiliated Hospital of Chongqing Medical University from February 1, 2016, to December 31, 2018. We applied six machine learning (ML) algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET), coupled with preoperative clinical characteristics and intraoperative information to develop prediction models for CLNM. Among all the samples, 70% were randomly selected to train the models while the remaining 30% were used for validation. Indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance.Results: The results showed that ~51.3% (652 out of 1,271) of the patients had pN1 disease. In multivariate logistic regression analyses, gender, tumor size and location, multifocality, age, and Delphian lymph node status were all independent predictors of CLNM. In predicting CLNM, six ML algorithms posted AUROC of 0.70–0.75, with the extreme gradient boosting (XGBoost) model standing out, registering 0.75. Thus, we employed the best-performing ML algorithm model and uploaded the results to a self-made online risk calculator to estimate an individual's probability of CLNM (https://jin63.shinyapps.io/ML_CLNM/).Conclusions: With the incorporation of preoperative and intraoperative risk factors, ML algorithms can achieve acceptable prediction of CLNM with Xgboost model performing the best. Our online risk calculator based on ML algorithm may help determine the optimal extent of initial surgical treatment for patients with T1-T2 stage, non-invasive, and clinically node negative PTC.

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“…The study by these researchers found that cervical lymph node metastases conferred an increased risk of death in all patients with follicular carcinoma and in those patients with PTC who were > 45 years old ( 8 ). A retrospective analysis of 399 patients demonstrated that prophylactic central compartment (level VI) neck dissection (CCND) improved disease-free survival in patients with intermediate- and high-risk differentiated thyroid carcinoma ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Sonographic Characteristics of Papillary Thyroid Carcinoma With Coexistent Hashimoto’s Thyroiditis in the Preoperative Prediction of Central Lymph Node Metastasis

et al. 2021

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The purpose of this study was to evaluate the usefulness of the sonographic characteristics of papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT) for predicting central lymph node metastasis (CLNM). One hundred thirty-three patients who underwent thyroidectomy and central cervical lymph node dissection for PTC with coexistent HT were retrospectively analyzed. All PTCs with HT were preoperatively evaluated by ultrasound (US) regarding their nodular number, size, component, shape, margin, echogenicity, calcification, capsule contact with protrusion, vascularity and contrast enhanced ultrasound (CEUS) parameters. Univariate analysis demonstrated that patients with PTCs with HT and CLNM more frequently had age ≤ 45 years, size > 10 mm, a wider than tall shape, microcalcification, hypo-enhancement and peak intensity index < 1 than those without CLNM (all p<0.05). Binary logistic regression analysis demonstrated that size > 10 mm and CEUS hypo-enhancement were independent characteristics for the presence of CLNM. Our study indicated that preoperative US characteristics could offer help in predicting CLNM in PTCs with coexistent HT.

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Prophylactic Central Lymph Node Dissection Improves Disease-Free Survival in Patients with Intermediate and High Risk Differentiated Thyroid Carcinoma: A Retrospective Analysis on 399 Patients

Cited by 32 publications

References 36 publications

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer

A Prediction Model for Contralateral Central Neck Lymph Node Metastases in Unilateral Papillary Thyroid Cancer

Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma

Sonographic Characteristics of Papillary Thyroid Carcinoma With Coexistent Hashimoto’s Thyroiditis in the Preoperative Prediction of Central Lymph Node Metastasis

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