Department of Head and Neck Surgical Oncology, National Cancer Centre, National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University/Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otolaryngology, Beijing, China.
BMC Cancer. 2023 Aug 1;23(1):718. doi: 10.1186/s12885-023-11219-0.
Identifying risk factors for occult lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) can provide valuable insights into the necessity of lateral neck dissection (LND). The objective of this study was to develop a nomogram for predicting the probability of LLNM in patients with cN0 unifocal PTMC.
We conducted a retrospective analyzed a total of 4872 patients with cN0 unifocal PTMC who were treated at our center from January 2013 to June 2018. Logistic regression analysis was used to determine the risk factors for LLNM, and a nomogram was constructed based on these risk factors.
The rate of LLNM was 3.2%. Tumors located in the upper lobe(odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.80-3.62; p < 0.001) and size greater than 7 mm (OR = 2.59, 95% CI 1.85-3.62; p < 0.001) had a significantly higher risk of LLNM compared to tumors in the lower or middle lobe and size less than or equal to 7 mm. Tumors with extrathyroidal extension (ETE) had a significantly higher risk of LLNM (OR = 1.41, 95% CI 1.01-1.99; p = 0.044). The presence of three or more central lymph node metastases (CLNMs) (OR = 5.84, 95% CI 3.83-8.93; p < 0.001) or one or two CLNMs (OR = 2.91, 95% CI 1.93-4.42; p < 0.001) also increased the risk of LLNM compared to having no CLNMs. A nomogram incorporating these risk factors was developed, and the receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) of 0.777, indicating a high degree of predictive accuracy.
Tumor location in the upper lobe, greater than 7 mm in size, ETE, and CLNMs, especially three or more, were independent risk factors for LLNM in cN0 unifocal PTMC. The nomogram based on these factors exhibited favorable predictive value and consistency.
识别甲状腺微小乳头状癌（PTMC）隐匿性侧颈部淋巴结转移（LLNM）的危险因素，有助于了解侧颈部清扫术（LND）的必要性。本研究旨在建立预测 cN0 单发 PTMC 患者 LLNM 概率的列线图。
回顾性分析了 2013 年 1 月至 2018 年 6 月在我院接受治疗的 4872 例 cN0 单发 PTMC 患者的临床资料。采用 logistic 回归分析确定 LLNM 的危险因素，并基于这些危险因素建立列线图。
LLNM 的发生率为 3.2%。与下或中叶及直径≤7mm 的肿瘤相比，上叶肿瘤（比值比[OR] = 2.56，95%置信区间[CI] 1.80-3.62；p < 0.001）和直径>7mm 的肿瘤（OR = 2.59，95% CI 1.85-3.62；p < 0.001）LLNM 的风险显著增加。有甲状腺外侵犯（ETE）的肿瘤发生 LLNM 的风险显著增加（OR = 1.41，95% CI 1.01-1.99；p = 0.044）。存在三个或更多中央淋巴结转移（CLNMs）（OR = 5.84，95% CI 3.83-8.93；p < 0.001）或存在一个或两个 CLNMs（OR = 2.91，95% CI 1.93-4.42；p < 0.001）与不存在 CLNMs 相比，LLNM 的风险也会增加。建立了一个包含这些危险因素的列线图，受试者工作特征（ROC）曲线的曲线下面积（AUC）为 0.777，表明具有较高的预测准确性。
肿瘤位于上叶、直径>7mm、ETE 以及中央淋巴结转移，尤其是三个或更多，是 cN0 单发 PTMC 患者发生 LLNM 的独立危险因素。基于这些因素的列线图具有良好的预测价值和一致性。
