General Surgery Department, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, China.
Department of Colorectal & Anal Surgery, Hepatobiliary & Enteric Surgery Rearch Center, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan Province, China.
World J Surg Oncol. 2020 Jul 15;18(1):167. doi: 10.1186/s12957-020-01948-y.
Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients.
A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated.
The incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342-5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017-1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710-17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736-0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful.
Based on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.
甲状腺乳头状癌（PTC）中无中央区淋巴结转移（CLNM）的侧区淋巴结转移（SLNM）被定义为跳跃性转移（SMS），但在临床实践中难以预测。本研究旨在探讨 PTC 患者 SMS 的危险因素，并建立预测 PTC 患者 SMS 概率的列线图。
回顾性分析 2018 年 3 月至 2019 年 7 月我院收治的 378 例临床疑似颈侧区淋巴结转移（CLNM）且接受改良根治性颈淋巴结清扫术（MRND）的 PTC 患者。采用单因素和多因素分析来探讨 SMS 的危险因素，并建立和内部验证列线图预测模型。
SMS 的发生率为 11.6%（44/378）。原发肿瘤直径≤1cm（OR=2.703；95%CI，1.342-5.464；P=0.005）、年龄（OR=1.051；95%CI，1.017-1.805；P=0.005）和肿瘤位于上极（OR=6.799；95%CI，2.710-17.060；P＜0.001）是 PTC 患者发生 SMS 的独立危险因素。基于这些预测因素的列线图表现良好，曲线下面积（AUC）为 0.806（95%CI，0.736-0.876），Hosmer-Lemeshow 拟合优度检验的 P 值为 0.66。决策曲线分析显示，该列线图具有临床应用价值。
基于 SMS 的危险因素，建立了一个高性能的列线图，可以为患者提供个体化风险评估，并指导治疗决策。
