Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Retrospective Study

Abstract

At present, the risk factors of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) are still controversial. This study was aimed to investigate the risk factors of various types of LNM in PTC with tumor diameter>1 cm. The clinical data of 2216 PTC patients were retrospectively analyzed. Univariate and multivariate logistic regression models were used to analyze the risk factors of LNM. In addition, the receiver operator characteristic (ROC) curve was used to find the best cut-off value of CLNM for predicting LLNM. Finally, the independent risk factors of LLNM were used to construct the prediction of LLNM nomogram. Age≤55 years old, male, bilateral lobe tumors, ETE, 2–3 cm tumor diameters, and fasting plasma glucose (FPG) were independent risk factors for CLNM. The ROC curve showed that the best cut-off value was 2.5. Age, male, bilateral lobe tumors, tumor diameters≥2 cm and CLNM≥3 were significantly associated with LLNM , while CLNM=1 or 2 was a protective factor for LLNM. Only tumor diameters≥3 cm was significantly associated with skip LLNM. The nomogram model (C-index=0.745) can be used to predict LLNM in PTC patients and guide the clinical selection of appropriate treatment options. Patients with high risk factors should undergo prophylactic lymph node dissection. The nomogram we established has a good predictive ability for LLNM, and for high-risk groups, it is necessary to actively perform prophylactic lateral lymph node dissection.

Key words

papillary thyroid carcinoma - lymph node metastasis - risk factor - prognosis

Publikationsverlauf

Eingereicht: 06. Januar 2023

Angenommen nach Revision: 19. März 2023

Accepted Manuscript online:
19. März 2023

Artikel online veröffentlicht:
02. Mai 2023

• References

• 1 Feng JW, Yang XH, Wu BQ. et al. Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma. Clin Transl Oncol 2019; 21: 1482-1491
• 2 Wang Y, Deng C, Shu X. et al. Risk factors and a prediction model of lateral lymph node metastasis in CN0 papillary thyroid carcinoma patients with 1–2 central lymph node metastases. Front Endocrinol (Lausanne) 2021; 12: 716728
• 3 Haugen BR, Alexander EK, Bible KC. et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26: 1-133
• 4 Yan B, Hou Y, Chen D. et al. Risk factors for contralateral central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma: A meta-analysis. Int J Surg 2018; 59: 90-98
• 5 Calo PG, Lombardi CP, Podda F. et al. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence. Updates Surg 2017; 69: 241-248
• 6 Feng Y, Min Y, Chen H. et al. Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest 2021; 44: 2203-2211
• 7 Liu C, Xiao C, Chen J. et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer 2019; 19: 622
• 8 So YK, Kim MJ, Kim S. et al. Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg 2018; 50: 94-103
• 9 Yan Y, Wang Y, Liu N. et al. Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma. Eur J Surg Oncol 2021; 47: 1727-1733
• 10 Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: Diagnosis of central and lateral compartment nodal metastases. Eur J Radiol 2019; 112: 14-21
• 11 Dirikoc A, Tam AA, Ince N. et al. Papillary thyroid microcarcinomas that metastasize to lymph nodes. Am J Otolaryngol 2021; 42: 103023
• 12 Zhao H, Huang T, Li H. Risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer. Surgery 2019; 166: 55-60
• 13 Nixon IJ, Wang LY, Ganly I. et al. Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection. Br J Surg 2016; 103: 218-225
• 14 Sancho JJ, Lennard TW, Paunovic I. et al. Prophylactic central neck disection in papillary thyroid cancer: a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2014; 399: 155-163
• 15 Yazici D, Colakoglu B, Saglam B. et al. Effect of prophylactic central neck dissection on the surgical outcomes in papillary thyroid cancer: experience in a single center. Eur Arch Otorhinolaryngol 2020; 277: 1491-1497
• 16 Thomas SN, Rohner NA, Edwards EE. Implications of lymphatic transport to lymph nodes in immunity and immunotherapy. Annu Rev Biomed Eng 2016; 18: 207-233
• 17 Tong Y, Li J, Huang Y. et al. Ultrasound-based radiomic nomogram for predicting lateral cervical lymph node metastasis in papillary thyroid carcinoma. Acad Radiol 2021; 28: 1675-1684
• 18 Feng JW, Qu Z, Qin AC. et al. Significance of multifocality in papillary thyroid carcinoma. Eur J Surg Oncol 2020; 46: 1820-1828
• 19 Li X, Duan Y, Liu D. et al. Diagnostic model incorporating clinicopathological characteristics of Delphian lymph node metastasis risk profiles in papillary thyroid cancer. Front Endocrinol (Lausanne) 2021; 12: 591015
• 20 Yang Z, Heng Y, Lin J. et al. Nomogram for predicting central lymph node metastasis in papillary thyroid cancer: a retrospective cohort study of two clinical centers. Cancer Res Treat 2020; 52: 1010-1018
• 21 du Bois H, Heim TA, Lund AW. Tumor-draining lymph nodes: at the crossroads of metastasis and immunity. Sci Immunol 2021; 6: eabg3551
• 22 Takano T. Natural history of thyroid cancer [Review]. Endocr J 2017; 64: 237-244
• 23 Guo X, Chen X, Zhang C. et al. Hyperinsulinemia and thyroid peroxidase antibody in Chinese patients with papillary thyroid cancer. Endocr J 2019; 66: 731-737
• 24 Huang Y, Chang A, Zhou W. et al. IGFBP3 as an indicator of lymph node metastasis and unfavorable prognosis for papillary thyroid carcinoma. Clin Exp Med 2020; 20: 515-525
• 25 Luo X, Wang J, Xu M. et al. Risk model and risk stratification to preoperatively predict central lymph node metastasis in papillary thyroid carcinoma. Gland Surg 2020; 9: 300-310
• 26 Heng Y, Yang Z, Zhou L. et al. Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis. Endocrine 2020; 68: 320-328
• 27 Medas F, Canu GL, Cappellacci F. et al. Predictive factors of lymph node metastasis in patients with papillary microcarcinoma of the thyroid: retrospective analysis on 293 cases. Front Endocrinol (Lausanne) 2020; 11: 551
• 28 Zeng RC, Zhang W, Gao EL. et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck 2014; 36: 101-106
• 29 Feng JW, Qin AC, Ye J. et al. Predictive factors for lateral lymph node metastasis and skip metastasis in papillary thyroid carcinoma. Endocr Pathol 2020; 31: 67-76
• 30 Wang W, Yang Z, Ouyang Q. A nomogram to predict skip metastasis in papillary thyroid cancer. World J Surg Oncol 2020; 18: 167
• 31 Hou J, Zhang Y, Fan Y. et al. Risk factors of skip lateral lymph node metastasis in papillary thyroid carcinoma. Eur Arch Otorhinolaryngol 2021; 278: 493-498