Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Endocrinol (Lausanne). 2022 May 20;13:868606. doi: 10.3389/fendo.2022.868606. eCollection 2022.
Central lymph node metastasis (CLNM) is regarded as a predictor for local recurrence in patients with papillary thyroid carcinoma (PTC) but the role of prophylactic central lymph node dissection (CLND) is controversial. Our study aims to identify the clinical factors associated with CLNM and develop a nomogram for making individualized clinical decisions.
The perioperative data of 1,054 consecutive patients between Jan 2019 and April 2021, in our center, were reviewed and analyzed. A total of 747 patients with histopathologically confirmed classical PTC were included as the training cohort and 374 (50% training cases) patients were randomly selected to build a validating cohort internal bootstrap analysis. Univariate and multivariate logistic regression were used to analyze the correlation between clinicopathological characteristics and CLNM.
In the training cohort, 33.6% (251/747) of patients with classical PTC were confirmed with CLNM. And the CLNM was determined in 31.4% (168/535) of non-Hashimoto's thyroiditis (HT) patients versus 39.2% (83/212) in HT patients (p=0.043). Four factors including gender, age, size, and HT status were confirmed significantly associated with CLNM. The established nomogram showed good discrimination and consistency with a C-index of 0.703, supported by the internal validation cohort with a C-index of 0.701. The decision curve analysis showed the nomogram has promising clinical feasibility.
Our study suggested that classical PTC patients with features like male gender, age<55 years old, tumor size>1cm, and HT condition had a higher risk of CLNM. And the nomogram we developed can help surgeons make individualized clinical decisions in classical PTC patients during preoperative and intraoperative management.
中央淋巴结转移（CLNM）被认为是甲状腺乳头状癌（PTC）患者局部复发的预测因素，但预防性中央淋巴结清扫术（CLND）的作用仍存在争议。本研究旨在确定与 CLNM 相关的临床因素，并制定用于做出个体化临床决策的列线图。
回顾性分析 2019 年 1 月至 2021 年 4 月期间在我中心接受治疗的 1054 例连续患者的围手术期数据。共有 747 例经组织病理学证实为经典型 PTC 的患者被纳入训练队列，其中 374 例（训练病例的 50%）患者被随机选择构建验证队列进行内部自举分析。使用单变量和多变量逻辑回归分析临床病理特征与 CLNM 之间的相关性。
在训练队列中，33.6%（251/747）的经典型 PTC 患者被证实存在 CLNM。非桥本甲状腺炎（HT）患者中 CLNM 的发生率为 31.4%（168/535），而 HT 患者中 CLNM 的发生率为 39.2%（83/212）（p=0.043）。包括性别、年龄、大小和 HT 状态在内的四个因素被确定与 CLNM 显著相关。建立的列线图显示出良好的区分度和一致性，内部验证队列的 C 指数为 0.701。决策曲线分析表明，该列线图具有良好的临床可行性。
本研究表明，具有男性性别、年龄<55 岁、肿瘤大小>1cm 和 HT 状态等特征的经典型 PTC 患者发生 CLNM 的风险更高。我们开发的列线图可帮助外科医生在术前和术中管理期间为经典型 PTC 患者做出个体化的临床决策。
