Heng Yu, Yang Zheyu, Cao Pengyu, Cheng Xi, Tao Lei
ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China.
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200031, China.
J Clin Med. 2022 Aug 24;11(17):4975. doi: 10.3390/jcm11174975.
Objective: To quantitatively predict the probability of lateral lymph node metastasis (LLNM) for papillary thyroid carcinomas (PTC) patients with central lymph node metastasis (CLNM) in order to guide postoperative adjuvant treatment. Methods: Five hundred and three PTC patients with CLNM from three medical centers were retrospectively analyzed. Results: The LLNM rate for all patients was 23.9% (120 in 503), with 15.5% (45 in 291) and 35.4% (75 in 212) for patients with papillary thyroid microcarcinoma (PTMC) and large papillary thyroid carcinoma (LPTC), respectively. Patients with no fewer than five positive central lymph nodes (CLN) exhibited a higher risk of LLNM. For patients with fewer than five positive CLN, a maximum diameter of positive CLN > 0.5 cm and the presence of ipsilateral nodular goiter were identified as independent risk factors of LLNM for papillary thyroid microcarcinoma (PTMC) patients. The independent risk factors of LLNM for large papillary thyroid carcinoma (LPTC) patients included a tumor located in the upper portion of thyroid, maximum tumor diameter ≥ 2.0 cm, maximum diameter of positive CLN > 0.5 cm, and the presence of thyroid capsular invasion. Predictive nomograms were established based on these risk factors for PTMC and LPTC patients, respectively. The accuracy and validity of our newly built models were verified by C-index and calibration curves. PTMC and LPTC patients with fewer than five positive CLN were each stratified into three subgroups based on their nomogram risk scores, and a detailed risk stratification flow chart was established for a more accurate evaluation of LLNM risk in PTC patients. Conclusions: A detailed stratification flow chart for PTC patients with CLNM to quantitatively assess LLNM risk was established, which may aid in clinical decision-making for those patients.
定量预测伴有中央区淋巴结转移（CLNM）的甲状腺乳头状癌（PTC）患者发生侧方淋巴结转移（LLNM）的概率，以指导术后辅助治疗。方法：回顾性分析来自三个医疗中心的503例伴有CLNM的PTC患者。结果：所有患者的LLNM发生率为23.9%（503例中的120例），甲状腺微小乳头状癌（PTMC）和甲状腺大乳头状癌（LPTC）患者的发生率分别为15.5%（291例中的45例）和35.4%（212例中的75例）。中央区淋巴结（CLN）阳性数不少于5个的患者发生LLNM的风险更高。对于CLN阳性数少于5个的患者，CLN阳性最大直径>0.5 cm以及同侧结节性甲状腺肿的存在被确定为PTMC患者发生LLNM的独立危险因素。LPTC患者发生LLNM的独立危险因素包括肿瘤位于甲状腺上部、最大肿瘤直径≥2.0 cm、CLN阳性最大直径 > 0.5 cm以及存在甲状腺被膜侵犯。分别基于这些危险因素为PTMC和LPTC患者建立了预测列线图。通过C指数和校准曲线验证了我们新建立模型的准确性和有效性。CLN阳性数少于5个的PTMC和LPTC患者根据其列线图风险评分各自分为三个亚组，并建立了详细的风险分层流程图，以更准确地评估PTC患者的LLNM风险。结论：建立了伴有CLNM的PTC患者定量评估LLNM风险的详细分层流程图，这可能有助于这些患者的临床决策。
