The Prediction of Metastases of Lateral Cervical Lymph Node in Medullary Thyroid Carcinoma

Abstract

PurposeDevelopment and validation of a nomogram for the prediction of lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC).MethodsWe retrospectively reviewed the clinical features of patients with MTC in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017 and in our Department of Surgical Oncology, Hangzhou First People’s Hospital between 2009 and 2019. The log‐rank test was used to compare the difference in the Kaplan–Meier (K–M) curves in recurrence and survival. The nomogram was developed to predict the risk of LLNM in MTC patients. The prediction efficiency of the predictive model was assessed by area under the curve (AUC) and concordance index (C-index) and calibration curves. Decision curve analysis (DCA) was performed to determine the clinic value of the predictive model.ResultA total of 714 patients in the SEER database and 35 patients in our department were enrolled in our study. Patients with LLNM had worse recurrence rate and cancer-specific survival (CSS) compared with patients without LLNM. Five clinical characteristics including sex, tumor size, multifocality, extrathyroidal extension, and distant metastasis were identified to be associated with LLNM in MTC patients, which were used to develop a nomogram. Our prediction model had satisfied discrimination with a C-index of 0.825, supported by both training set and internal testing set with a C-index of 0.825, and 0.816, respectively. DCA was further made to evaluate the clinical utility of this nomogram for predicting LLNM.ConclusionsMale sex, tumor size >38mm, multifocality, extrathyroidal extension, and distant metastasis in MTC patients were significant risk factors for predicting LLNM.

Nomogram for Predicting Lateral Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Retrospective Cohort Study of Single Clinical Center

“…Besides the above risk factors, we also found some auxiliary risk factors. Capsular invasion was associated with tumor aggressiveness of MTC and LNM, as shown by various studies [11,13,15], which was inconsistent with our analysis. TG was a tumor marker produced in the thyroid gland, which was used in the follow-up and management of patients with DTC [16].…”

“…In a cohort of 5817 consecutive patients with thyroid nodules, Costante et al [12] reported a statistically signi cant relationship between larger diameter and higher preoperative serum CT level, which indicated higher tumor burden and lymph node metastasis. Similar conclusions were drawn in other reports [6,13].…”

High rates of aggressive features in young Vietnamese females with papillary thyroid carcinoma: Associations with preoperative risk factors

“…However, our study found a high prevalence of capsular invasion (58.7%) and cervical lymph node metastasis (28.5%) among patients with thyroid carcinoma. These findings diverge from some recent literature reporting lower rates of capsular invasion (around 30%) [6,21] and nodal metastases (15%-50%) in similar cohorts [22][23][24] . The elevated incidence of capsular breach indicates more aggressive tumor behavior, with implications for increased extrathyroidal extension and lymphatic spread [25,26] .…”

Combination of ultrasound and serological tests for detecting occult lateral lymph node metastases in medullary thyroid cancer

“…Our results are consistent with previous literature regarding the ultrasonic features of the tumor diameters, postoperative serological markers and the usefulness of ultrasound in detecting LLNM. Other prognostic factors were suggested by some studies, including male sex, 17 , 28 distal metastasis, 17 , 28 multifocality, 28 and ratio of postoperative calcitonin to preoperative calcitonin, 29 as a ratio above 0.15 indicates poorer prognosis. As reviewed by Ahn et al 30 there is a negative association between the frequency of ipsilateral lateral neck dissections and the rate of death caused by MTC ( p = 0.0017), so careful consideration regarding the extent of surgery should be taken for the benefit of patients.…”