Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, Shenyang, China.
Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of General Medicine, Liaoning Province, Shenyang, China.
Braz J Otorhinolaryngol. 2023 Sep-Oct;89(5):101301. doi: 10.1016/j.bjorl.2023.101301. Epub 2023 Aug 3.
Lateral Lymph Node Metastasis (LLNM) is common in Papillary Thyroid Carcinoma (PTC) and is associated with a poor prognosis. LLNM without central lymph node metastasis as skip metastasis is not common. We aimed to investigate clinicopathologic and sonographic risk factors for skip metastasis in PTC patients, and to establish a nomogram for predicting the possibility of skip metastasis in order to determine the therapeutic strategy. We retrospectively reviewed the data of 1037 PTC patients who underwent surgery from 2016 to 2020 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic and preoperative sonographic risk factors of skip metastasis. A nomogram including the risk factors for predicting skip metastasis was further developed and validated. The incidence of skip metastasis was 10.7%. The univariate and multivariate analyses suggested that gender (p= 0.001), tumor location (p= 0.000), extrathyroidal extension (p= 0.000), and calcification (p= 0.000) were independent risk factors. For papillary thyroid microcarcinoma, tumor location (p= 0.000) and calcification (p= 0.001) were independent risk factors. A nomogram according to the clinicopathologic and sonographic predictors was developed. The receiver operating characteristic curve indicated that AUC was 0.824 and had an excellent consistency. The calibration plot analysis showed a good performance and clinical utility of the model. Decision curve analysis revealed it was clinically useful. A nomogram for predicting the probability of skip metastasis was developed, which exhibited a favorable predictive value and consistency. For the female PTC patient, tumor located at the upper pole is more likely to have skip metastasis. Surgeons and sonographers should pay close attention to the patients who have the risk factors. Evidence level: This article's evidence level is 3. Level 3 evidence is derived from non-randomized, controlled clinical trials. In this study, patients who receive an intervention are compared to a control group. Authors may detect a statistically significant and clinically relevant outcome.
侧颈部淋巴结转移（LLNM）在甲状腺乳头状癌（PTC）中很常见，与预后不良有关。无中央淋巴结转移的侧颈部跳跃性转移并不常见。我们旨在探讨 PTC 患者侧颈部跳跃性转移的临床病理和超声危险因素，并建立预测跳跃性转移可能性的列线图，以确定治疗策略。我们回顾性分析了 2016 年至 2020 年在一家机构接受手术治疗的 1037 例 PTC 患者的数据。使用单因素和多因素分析来确定侧颈部跳跃性转移的临床病理和术前超声危险因素。进一步开发和验证了包含预测侧颈部跳跃性转移风险因素的列线图。跳跃性转移的发生率为 10.7%。单因素和多因素分析表明，性别（p=0.001）、肿瘤位置（p=0.000）、甲状腺外侵犯（p=0.000）和钙化（p=0.000）是独立的危险因素。对于甲状腺微小乳头状癌，肿瘤位置（p=0.000）和钙化（p=0.001）是独立的危险因素。根据临床病理和超声预测因素制定了列线图。受试者工作特征曲线表明 AUC 为 0.824，具有良好的一致性。校准图分析表明模型具有良好的性能和临床实用性。决策曲线分析表明其具有临床实用性。建立了预测侧颈部跳跃性转移概率的列线图，具有良好的预测值和一致性。对于女性 PTC 患者，位于上极的肿瘤更有可能发生侧颈部跳跃性转移。外科医生和超声医生应密切关注具有这些危险因素的患者。证据等级：本文的证据等级为 3 级。3 级证据来源于非随机对照临床试验。在本研究中，接受干预的患者与对照组进行比较。作者可能会发现具有统计学意义和临床相关的结果。
