Risk factors for the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma_West China Medical Journal

Authors：

YUE Can ¹ , HU Haiping ² , JIANG Yong ³ , SHANG Lei ¹ ,  MA Buyun ¹

1. Department of Ultrasound Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Ultrasound Medicine, Longchang People’s Hospital, Longchang, Sichuan 642150, P. R. China;
3. Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

MA Buyun, Email: ws_mby@126.com

Keywords：

Papillary thyroid microcarcinoma; ultrasound; central cervical lymph node micrometastasis

DOI：

10.7507/1002-0179.202104171

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Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma (PTMC). Methods PTMC patients who underwent surgical operations in West China Hospital, Sichuan University between January 2014 and December 2018 were retrospectively enrolled. The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound. During the operation, the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck. With postoperative pathology as the gold standard, patients were divided into central cervical lymph node micrometastasis group (micrometastasis group) and central cervical lymph node non-metastasis group (non-metastasis group). The differences of clinical features and ultrasonic signs between the two groups were analyzed. Results A total of 507 patients were included, including 223 (44.0%) in the micrometastasis group and 284(56.0%) in the non-metastasis group. The results of univariate analysis showed that compared with the non-metastasis group, the patients in the micrometastasis group were younger, the tumor size were higher, the proportion of male, multifocality, bilateral involvement and thyroid capsular invasion were higher. The results of multiple logistic regression analysis showed that lower age [odds radio (OR)=0.967, 95% confidence interval (CI)(0.949, 0.985), P<0.001], male [OR=2.357, 95%CI (1.503, 3.694), P<0.001)], a larger maximum diameter of PTMC [OR=1.232, 95%CI (1.100, 1.379), P<0.001], a larger nodule volume of PTMC [OR=1.031, 95%CI (1.008, 1.114), P=0.032], multifocal lesion [OR=2.309, 95%CI (1.167, 4.570), P=0.016] and invasion of the thyroid capsule [OR=1.520, 95%CI (1.010, 2.286), P=0.045] were independent risk factors for central cervical lymph node micrometastasis. Conclusions The patient’s male, young age, PTMC nodule with large maximum diameter and large volume, multifocal, and invasion of the thyroid membrane are risk factors for the central cervical lymph node micrometastasis of PMTC patients. These clinical and ultrasound signs can provide a theoretical basis for doctors’ clinical management decisions.

Citation： YUE Can, HU Haiping, JIANG Yong, SHANG Lei, MA Buyun. Risk factors for the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma. West China Medical Journal, 2023, 38(3): 438-443. doi: 10.7507/1002-0179.202104171 Copy

1.	Morris LG, Tuttle RM, Davies L. Changing trends in the incidence of thyroid cancer in the United States. JAMA Otolaryngol Head Neck Surg, 2016, 142(7): 709-711.
2.	高明, 葛明华, 嵇庆海, 等. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016 版). 中国肿瘤临床, 2016, 43(10): 405-411.
3.	La Vecchia C, Malvezzi M, Bosetti C, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer, 2015, 136(9): 2187-2195.
4.	Siddiqui S, White MG, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma. Thyroid, 2016, 26(6): 807-815.
5.	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): 1-133.
6.	Leboulleux S, Tuttle RM, Pacini F, et al. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance?. Lancet Diabetes Endocrinol, 2016, 4(11): 933-942.
7.	Chang YW, Kim HS, Kim HY, et al. Should central lymph node dissection be considered for all papillary thyroid microcarcinoma?. Asian J Surg, 2016, 39(4): 197-201.
8.	Galofré JC. The dilemma of papillary thyroid microcarcinoma management. To operate or not to operate, that is the question. Endocrinol Diabetes Nutr (Engl Ed), 2019, 66(8): 469-471.
9.	Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
10.	中华医学会超声医学分会浅表器官和血管学组, 中国甲状腺与乳腺超声人工智能联盟. 2020 甲状腺结节超声恶性危险分层中国指南: C-TIRADS. 中华超声影像学杂志, 2021, 30(3): 185-200.
11.	侯庆, 陈宇, 马步云, 等. 超声评估甲状腺结节内不同钙化类型的临床研究. 西部医学, 2016, 28(9): 1297-1301.
12.	Oh EM, Chung YS, Song WJ, et al. The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography. Ann Surg Treat Res, 2014, 86(3): 115-121.
13.	Kuşcu O, Önay Ö, Kayahan B, et al. The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not?. Otolaryngol Pol, 2016, 70(3): 15-19.
14.	Kim JY, Jung EJ, Park T, et al. Impact of tumor size on subclinical central lymph node metastasis in papillary thyroid microcarcinoma depends on age. World J Surg Oncol, 2015, 13: 88.
15.	Liu LS, Liang J, Li JH, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol, 2017, 274(3): 1327-1338.
16.	Cho SY, Lee TH, Ku YH, et al. Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery, 2014, 157(1): 111-118.
17.	Zhao Q, Ming J, Liu C, et al. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol, 2013, 20(3): 746-752.
18.	Park JP, Roh J, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3): 412-418.
19.	Yang Y, Chen C, Chen Z, et al. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf), 2014, 81(2): 282-288.
20.	Trovisco V, Soares P, Preto A, et al. Type and prevalence of BRAF mutations are closely associated with papillary thyroid carcinoma histotype and patients’ age but not with tumour aggressiveness. Virchows Arch, 2005, 446(6): 589-595.
21.	Mathur A, Moses W, Rahbari R, et al. Higher rate of BRAF mutation in papillary thyroid cancer over time: a single-institution study. Cancer, 2011, 117(19): 4390-4395.
22.	Tufano RP, Teixeira GV, Bishop J, et al. BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment. Medicine (Baltimore), 2012, 91(5): 274-286.
23.	Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF ^V600E mutation and recurrence of papillary thyroid cancer. J Clin Oncol, 2015, 33(1): 42-50.
24.	Kwak JY, Kim EK, Chung WY, 等. 韩国甲状腺乳头状微小癌病人中(癌基因) BRAF ^V600E 突变与临床预后不良因素及其超声特征之间的关系. 国际医学放射学杂志, 2010, 33(1): 86.
25.	Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg, 2014, 255(4): 777-783.
26.	Ross DS, Litofsky D, Ain KB, et al. Recurrence after treatment of micropapillary thyroid cancer. Thyroid, 2009, 19(10): 1043-1048.
27.	Lee J, Song Y, Soh EY. Prognostic significance of the number of metastatic lymph nodes to stratify the risk of recurrence. World J Surg, 2014, 38(4): 858-862.
28.	Ito Y, Miyauchi A, Kihara M, et al. Relationship between prognosis of papillary thyroid carcinoma patient and age: a retrospective single-institution study. Endocr J, 2012, 59(5): 399-405.
29.	Mazzaferri EL, Jhiang SM. Long-term Impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 1994, 97(5): 418-428.

1. Morris LG, Tuttle RM, Davies L. Changing trends in the incidence of thyroid cancer in the United States. JAMA Otolaryngol Head Neck Surg, 2016, 142(7): 709-711.
2. 高明, 葛明华, 嵇庆海, 等. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016 版). 中国肿瘤临床, 2016, 43(10): 405-411.
3. La Vecchia C, Malvezzi M, Bosetti C, et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer, 2015, 136(9): 2187-2195.
4. Siddiqui S, White MG, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma. Thyroid, 2016, 26(6): 807-815.
5. 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): 1-133.
6. Leboulleux S, Tuttle RM, Pacini F, et al. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance?. Lancet Diabetes Endocrinol, 2016, 4(11): 933-942.
7. Chang YW, Kim HS, Kim HY, et al. Should central lymph node dissection be considered for all papillary thyroid microcarcinoma?. Asian J Surg, 2016, 39(4): 197-201.
8. Galofré JC. The dilemma of papillary thyroid microcarcinoma management. To operate or not to operate, that is the question. Endocrinol Diabetes Nutr (Engl Ed), 2019, 66(8): 469-471.
9. Sugitani I, Toda K, Yamada K, et al. Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: our treatment strategies and outcomes. World J Surg, 2010, 34(6): 1222-1231.
10. 中华医学会超声医学分会浅表器官和血管学组, 中国甲状腺与乳腺超声人工智能联盟. 2020 甲状腺结节超声恶性危险分层中国指南: C-TIRADS. 中华超声影像学杂志, 2021, 30(3): 185-200.
11. 侯庆, 陈宇, 马步云, 等. 超声评估甲状腺结节内不同钙化类型的临床研究. 西部医学, 2016, 28(9): 1297-1301.
12. Oh EM, Chung YS, Song WJ, et al. The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography. Ann Surg Treat Res, 2014, 86(3): 115-121.
13. Kuşcu O, Önay Ö, Kayahan B, et al. The rising incidence of papillary thyroid microcarcinoma and is completion surgery necessary or not?. Otolaryngol Pol, 2016, 70(3): 15-19.
14. Kim JY, Jung EJ, Park T, et al. Impact of tumor size on subclinical central lymph node metastasis in papillary thyroid microcarcinoma depends on age. World J Surg Oncol, 2015, 13: 88.
15. Liu LS, Liang J, Li JH, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis. Eur Arch Otorhinolaryngol, 2017, 274(3): 1327-1338.
16. Cho SY, Lee TH, Ku YH, et al. Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery, 2014, 157(1): 111-118.
17. Zhao Q, Ming J, Liu C, et al. Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol, 2013, 20(3): 746-752.
18. Park JP, Roh J, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3): 412-418.
19. Yang Y, Chen C, Chen Z, et al. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf), 2014, 81(2): 282-288.
20. Trovisco V, Soares P, Preto A, et al. Type and prevalence of BRAF mutations are closely associated with papillary thyroid carcinoma histotype and patients’ age but not with tumour aggressiveness. Virchows Arch, 2005, 446(6): 589-595.
21. Mathur A, Moses W, Rahbari R, et al. Higher rate of BRAF mutation in papillary thyroid cancer over time: a single-institution study. Cancer, 2011, 117(19): 4390-4395.
22. Tufano RP, Teixeira GV, Bishop J, et al. BRAF mutation in papillary thyroid cancer and its value in tailoring initial treatment. Medicine (Baltimore), 2012, 91(5): 274-286.
23. Xing M, Alzahrani AS, Carson KA, et al. Association between BRAF ^V600E mutation and recurrence of papillary thyroid cancer. J Clin Oncol, 2015, 33(1): 42-50.
24. Kwak JY, Kim EK, Chung WY, 等. 韩国甲状腺乳头状微小癌病人中(癌基因) BRAF ^V600E 突变与临床预后不良因素及其超声特征之间的关系. 国际医学放射学杂志, 2010, 33(1): 86.
25. Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg, 2014, 255(4): 777-783.
26. Ross DS, Litofsky D, Ain KB, et al. Recurrence after treatment of micropapillary thyroid cancer. Thyroid, 2009, 19(10): 1043-1048.
27. Lee J, Song Y, Soh EY. Prognostic significance of the number of metastatic lymph nodes to stratify the risk of recurrence. World J Surg, 2014, 38(4): 858-862.
28. Ito Y, Miyauchi A, Kihara M, et al. Relationship between prognosis of papillary thyroid carcinoma patient and age: a retrospective single-institution study. Endocr J, 2012, 59(5): 399-405.
29. Mazzaferri EL, Jhiang SM. Long-term Impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med, 1994, 97(5): 418-428.

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Risk factors for the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma

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