Wang Zhiyuan, Gui Zhiqiang, Wang Zhihong, Huang Jiapeng, He Liang, Dong Wenwu, Zhang Dalin, Zhang Ting, Shao Liang, Shi Jinyuan, Wu Pu, Ji Xiaoyu, Zhang Hao, Sun Wei
Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, P. R. China.
Clin Endocrinol (Oxf). 2023 Apr;98(4):609-621. doi: 10.1111/cen.14834. Epub 2022 Nov 3.
Papillary thyroid microcarcinoma (PTMC) comprises more than 50% of all newly detected cases of papillary thyroid carcinoma (PTC). High-volume lymph node metastasis (involving >5 lymph nodes) (hv-LNM) is associated with PTMC recurrence. In half of the clinically node-negative (cN0) PTMC patients, central lymph node metastasis (CLNM) is pathologically present. However, clinical risk factors for high-volume CLNM (hv-CLNM) in cN0 PTMC have not been defined well. Therefore, we aimed to obtain evidence for hv-CLNM risk factors in cN0 PTMC.
Data on patients who visited our hospital between January 2020 and December 2021 were collected; a preoperative diagnosis of cN0 and a postoperative pathological confirmation of PTMC were obtained. After filtering by inclusion versus exclusion criteria, the obtained data (N = 2268) were included in the meta-analysis. Relevant studies published as of 10 April 2022, were identified from the Web of Science, PubMed, WANFANG, and CNKI databases. These eligible studies were included in the meta-analysis and the association between clinicopathological factors and hv-CLNM in cN0 PTMC was assessed. SPSS and MetaXL were used for statistical analyses.
The meta-analysis included 10 previous studies (11,734 patients) and 2268 patients enroled in our hospital for a total of 14,002 subjects. The results of which suggested that younger age (<40, odds ratio [OR] = 3.28, 95% confidence interval [CI] = 2.75-3.92, p < .001 or <45 odds ratio [OR] = 2.93, 95% CI = 2.31-3.72, p < .001), male sex (OR = 2.81, 95% CI = 2.25-3.52, p < .001), tumour size >5 mm (OR = 1.85, 95% CI = 1.39-2.47, p < .001), multifocality (OR = 1.88, 95% CI = 1.56-2.26, p < .001), extrathyroidal extension (OR = 2.58, 95% CI = 2.02-3.30, p < .001), capsule invasion (OR = 2.02, 95% CI = 1.46-2.78, p < .001), microcalcification (OR = 3.25, 95% CI = 2.42-4.36, p < .001) and rich blood flow (OR = 1.65, 95% CI = 1.21-2.25, p = .002) were the significant factors related to an elevated hv-CLNM risk in cN0 PTMC patients. Hashimoto thyroiditis (OR = 0.76, 95% CI = 0.55-1.07, p = .114), irregular margin (versus regular margin, OR = 0.96, 95% CI = 0.68-1.33, p = .787) and hypoechoic (versus nonhypoechoic, OR = 1.27, 95% CI = 0.84-1.92, p = .261) showed no significant association with hv-CLNM.
Younger age, tumour size >5 mm, males, extrathyroidal extension, multifocality, microcalcification, capsular invasion, and rich blood flow were the significant clinicopathological risk factors for hv-CLNM risk in cN0 PTMC patients. These predictors may compensate for the sensitivity of imaging diagnosis in the preoperative period, thus helping in the effective identification of PTMCs with an invasive phenotype.
甲状腺微小乳头状癌（PTMC）占所有新诊断出的甲状腺乳头状癌（PTC）病例的50%以上。高容量淋巴结转移（累及>5个淋巴结）（hv-LNM）与PTMC复发相关。在一半临床淋巴结阴性（cN0）的PTMC患者中，病理检查发现存在中央淋巴结转移（CLNM）。然而，cN0 PTMC患者中高容量CLNM（hv-CLNM）的临床危险因素尚未明确界定。因此，我们旨在获取cN0 PTMC患者中hv-CLNM危险因素的证据。
收集2020年1月至2021年12月期间来我院就诊患者的数据；获得术前cN0诊断及术后PTMC病理确诊结果。经纳入与排除标准筛选后，将获得的数据（N = 2268）纳入荟萃分析。从Web of Science、PubMed、万方和知网数据库中检索截至2022年4月10日发表的相关研究。将这些符合条件的研究纳入荟萃分析，评估cN0 PTMC患者临床病理因素与hv-CLNM之间的关联。使用SPSS和MetaXL进行统计分析。
荟萃分析纳入了之前的10项研究（11734例患者）以及我院收治的2268例患者，共计14,002名受试者。结果表明，年龄较小（<40岁，比值比[OR]=3.28，95%置信区间[CI]=2.75 - 3.92，p <.001或<45岁，比值比[OR]=2.93，95% CI = 2.31 - 3.72，p <.001）、男性（OR = 2.81，95% CI = 2.25 - 3.5
