Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Endocr Pract. 2021 Jan;27(1):15-20. doi: 10.4158/EP-2020-0129. Epub 2020 Nov 18.
Some surgeons believe that dissection posterior to the right recurrent laryngeal nerve lymph node (PRRLN-LN) is unnecessary for the low metastasis rate and high complication risk. However, persistent metastatic lymph nodes may have a higher recurrence rate, surgical risk, and complications. Thus, it is important to distinguish patients who require PRRLN-LN dissection. To identify the risk factors for lymph nodes posterior to the right recurrent laryngeal nerve metastasis (LN-prRLN) and establish a scoring system to help determine whether PRRLN-LN dissection is required in patients with papillary thyroid carcinoma.
821 participants were randomly allocated to the development and validation cohorts in a 2:1 ratio. A nomogram-based predictive model for LN-prRLN was established based on the risk factors identified in the development cohort.
LN-prRLN was diagnosed pathologically in 124 of 821 patients (15.1%) from the entire cohort. Multivariate analysis identified age (odds ratio [OR], 0.964; 95% CI, 0.945-0.983; P < .001), tumor size (OR, 1.536; 95% CI, 1.135-2.079; P = .005), extrathyroidal extension (OR 2.271, 95% CI, 1.368-3.770; P = .002), clinically involved right central compartment lymph node metastasis (OR 1.643, 95% CI, 1.055-2.559; P = .028), and right lateral lymph node metastasis (OR 4.271, 95% CI, 2.325-7.844; P < .001) as the predictors of LN-prRLN. A risk model was established and well validated. Calibration curves to evaluate the nomogram in both the development and validation cohorts revealed a concordance index of 0.756 ± 0.058 and 0.745 ± 0.042, respectively.
Our scoring system may be useful for helping the surgeons decide which patients should undergo the dissection of PRRLN-LN.
一些外科医生认为，对于低转移率和高并发症风险，解剖右喉返神经淋巴结（PRRLN-LN）后方的淋巴结是不必要的。然而，持续存在的转移性淋巴结可能具有更高的复发率、手术风险和并发症。因此，区分需要进行 PRRLN-LN 解剖的患者非常重要。确定右喉返神经后淋巴结转移（LN-prRLN）的危险因素，并建立评分系统，以帮助确定患有甲状腺乳头状癌的患者是否需要进行 PRRLN-LN 解剖。
821 名参与者按照 2:1 的比例随机分配到开发和验证队列中。基于开发队列中确定的危险因素，建立了一个基于列线图的 LN-prRLN 预测模型。
整个队列中有 821 名患者（15.1%）经病理诊断为 LN-prRLN。多变量分析确定年龄（比值比 [OR]，0.964；95%CI，0.945-0.983；P<.001）、肿瘤大小（OR，1.536；95%CI，1.135-2.079；P=0.005）、甲状腺外延伸（OR，2.271；95%CI，1.368-3.770；P=0.002）、临床累及右侧中央隔腔淋巴结转移（OR，1.643；95%CI，1.055-2.559；P=0.028）和右侧侧颈淋巴结转移（OR，4.271；95%CI，2.325-7.844；P<.001）是 LN-prRLN 的预测因素。建立了一个风险模型并进行了良好的验证。在开发和验证队列中，校准曲线评估列线图的一致性指数分别为 0.756±0.058 和 0.745±0.042。
我们的评分系统可能有助于帮助外科医生决定哪些患者应该进行 PRRLN-LN 解剖。
