Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma

Abstract

The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.

Clinical-pathological Characteristics and Prognostic Factors for Papillary Thyroid Microcarcinoma in the Elderly

“…This study has also found that the risk of CSD in the male patients was 2.273 times higher than that in the females, similar to the findings by Lin et al 21 . Hsieh et al 22 reported that most elderly male patients in the late stages of the disease were prone to developing lymph node metastasis and distant metastasis, both of which resulted from the levels of sex hormone and unhealthy behavior (such as smoking and drinking).…”

Machine Learning Algorithms for the Prediction of Central Lymph Node Metastasis in Patients With Papillary Thyroid Cancer

“…In addition, a sex predisposition was also observed in our study. We found that males were associated with a higher incidence of CLNM, which was also supported by previous reports (16,17,(32)(33)(34)(35). Overall, male patients < 40 years old might be considered a high-risk population for CLNM and should be evaluated carefully when choosing surgical procedures.…”

“…Our study suggested that CLNM had a significant tendency to appear in young patients. The optimal cut-off age was 40 years old (AUC=0.648; sensitivity: 0.68; specificity: 0.56), which is similar to previous studies that reported age < 45 years was a risk factor for CLNM (16,17,32,33). In addition, a sex predisposition was also observed in our study.…”

Risk factors for post-thyroidectomy haemorrhage: a meta-analysis

“…However, males exhibited a 1.73-fold increased risk of post-thyroidectomy haemorrhage compared to females (OR = 1.73, 95% CI = 1.54-1.94, P < 0.00001), and the reason for the difference is unclear. As male was one of the risk factors of thyroid carcinoma (39), and lymph node metastasis was more likely to happen in male (40), which means that male thyroid surgery may be more complex. Some studies also suggest that male muscles are stronger and their contractions at awakening provoke the slipping of ligatures or the reopening of previously ligated vessels, thus causing haemorrhage.…”