ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
E.N.T Dept. Minhang Hospital Fudan University, Shanghai, China.
Endocrine. 2024 Dec;86(3):1045-1054. doi: 10.1007/s12020-024-03861-w. Epub 2024 Jul 25.
Mono-focal papillary thyroid carcinoma (PTC) patients with encapsulated tumor have traditionally been considered as low central lymph node metastasis (CLNM) risk subgroup. The aim of the research was to quantitatively predict the probability of CLNM for mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound based on pre- and post-operative indexes respectively to guide the selection of prophylactic central lymph node dissection (CLND) and follow-up strategies.
A total of 1014 mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound from three medical centers were retrospectively analyzed, with 534 patients served as Training group and 480 patients as Validation group.
Multivariate analyses showed that age < 55 years old, male, clinical maximum tumor diameter (cMTD) > 0.5 cm, pathological maximum tumor diameter (pMTD) > 0.5 cm, and the presence of microscopic thyroid capsular invasion (mTCI) were independent CLNM risk factors. These were used to construct two nomograms that can effectively predict the central neck involvement in mono-focal PTC patients with encapsulated tumor. The first nomogram (pre-model) provides quantitative assessment on the necessity of prophylactic CLND, while the second nomogram (post-model) informs postoperative follow-up strategies.
Meticulous and comprehensive stratification flow charts that quantitatively evaluate the risk of central lymph node metastasis both pre- and post-operatively were constructed for mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound, which may benefit both clinical decision-making of prophylactic CLND and postoperative follow-up strategies for the management of neck regions.
传统上，包膜内肿瘤的单灶甲状腺乳头状癌（PTC）患者被认为是中央淋巴结转移（CLNM）风险较低的亚组。本研究旨在分别基于术前和术后指标定量预测术前超声证实的包膜内单灶 PTC 患者 CLNM 的概率，以指导预防性中央淋巴结清扫（CLND）和随访策略的选择。
回顾性分析了来自三个医疗中心的 1014 例术前超声证实为包膜内肿瘤的单灶 PTC 患者，其中 534 例患者为训练组，480 例患者为验证组。
多因素分析显示，年龄<55 岁、男性、临床最大肿瘤直径（cMTD）>0.5cm、病理最大肿瘤直径（pMTD）>0.5cm 和存在显微镜下甲状腺被膜侵犯（mTCI）是 CLNM 的独立危险因素。这些因素被用于构建两个能够有效预测包膜内单灶 PTC 患者中央颈部受累的列线图。第一个列线图（术前模型）提供了预防性 CLND 的必要性的定量评估，而第二个列线图（术后模型）则提供了术后随访策略的信息。
为术前超声证实的包膜内单灶 PTC 患者构建了术前和术后定量评估中央淋巴结转移风险的精细和全面的分层流程图，这可能有利于预防性 CLND 的临床决策和颈部区域管理的术后随访策略。
