Analysis of risk factors for central lymph node metastasis in cN0 papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Wanxiao ¹ , NI Zhongpeng ¹ ,  CUI Huaixin ²

1. Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Department of General Surgery, Affiliated Xuzhou Clinical College of Xuzhou Medical University/Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

CUI Huaixin, Email: chen15215526603@163.com

Keywords：

papillary thyroid carcinoma; cN0 stage; central lymph node metastasis; risk factor; nomogram

DOI：

10.7507/1007-9424.202006084

Video：

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Objective To investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).Methods The clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.Results CLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.Conclusions CLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.

Citation： CHEN Wanxiao, NI Zhongpeng, CUI Huaixin. Analysis of risk factors for central lymph node metastasis in cN0 papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(4): 488-492. doi: 10.7507/1007-9424.202006084 Copy

1.	Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol, 2013, 2013: 965212.
2.	Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2): 237-244.
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): 1-133.
4.	Kowalski LP, Bagietto R, Lara JR, et al. Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck, 2000, 22(3): 207-214.
5.	中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
6.	American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 2009, 19(11): 1153-1158.
7.	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.
8.	Pitoia F, Bueno F, Urciuoli C, et al. Outcomes of patients with differentiated thyroid cancer risk-stratified according to the American thyroid association and Latin American thyroid society risk of recurrence classification systems. Thyroid, 2013, 23(11): 1401-1407.
9.	Adam MA, Pura J, Goffredo P, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol, 2015, 33(21): 2370-2375.
10.	Jeon MJ, Kim WG, Choi YM, et al. Recent changes in the clinical outcome of papillary thyroid carcinoma with cervical lymph node metastasis. J Clin Endocrinol Metab, 2015, 100(9): 3470-3477.
11.	Liu FH, Kuo SF, Hsueh C, et al. Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis. J Surg Oncol, 2015, 112(2): 149-154.
12.	Zhao W, You L, Hou X, et al. The effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and meta-analysis: pCND for the locoregional recurrence of papillary thyroid cancer. Ann Surg Oncol, 2017, 24(8): 2189-2198.
13.	Garcia A, Palmer BJ, Parks NA, et al. Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective. Clin Endocrinol (Oxf), 2014, 81(5): 754-761.
14.	Zheng CM, Ji YB, Song CM, et al. Number of metastatic lymph nodes and ratio of metastatic lymph nodes to total number of retrieved lymph nodes are risk factors for recurrence in patients with clinically node negative papillary thyroid carcinoma. Clin Exp Otorhinolaryngol, 2018, 11(1): 58-64.
15.	Calò 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(2): 241-248.
16.	Kim SK, Woo JW, Lee JH, et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11 569 cases from a single institution. J Am Coll Surg, 2016, 222(5): 853-864.
17.	Ji YB, Song CM, Sung ES, et al. Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy. Clin Exp Otorhinolaryngol, 2017, 10(3): 265-271.
18.	Mao LN, Wang P, Li ZY, et al. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett, 2015, 9(1): 103-107.
19.	Lee DY, Oh KH, Cho JG, et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. Int J Endocrinol, 2015, 2015: 571480.
20.	Qiao Y, Wang Y, Kang P, et al. The assessment of the accuracy of clinical preoperative lymph node. Medicine (Baltimore), 2019, 98(4): e13778.
21.	Jainulabdeen T, Ramaswamy B, Devaraja K, et al. Preoperative staging of differentiated thyroid carcinomas: comparison of USG and CT with intraoperative findings and histopathology. Indian J Otolaryngol Head Neck Surg, 2019, 71(3): 327-333.
22.	Suman P, Wang CH, Abadin SS, et al. Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study. Surgery, 2016, 159(1): 31-39.
23.	Ahn BH, Kim JR, Jeong HC, et al. Predictive factors of central lymph node metastasis in papillary thyroid carcinoma. Ann Surg Treat Res, 2015, 88(2): 63-68.
24.	Soylu L, Aydin OU, Ozbas S, et al. The impact of the multifocality and subtypes of papillary thyroid carcinoma on central compartment lymph node metastasis. Eur Rev Med Pharmacol Sci, 2016, 20(19): 3972-3979.
25.	Tang T, Li J, Zheng L, et al. Risk factors of central lymph node metastasis in papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2018, 54(Pt A): 129-132.
26.	Yan H, Zhou X, Jin H, et al. A study on central lymph node metastasis in 543 CN0 papillary thyroid carcinoma patients. Int J Endocrinol, 2016, 2016: 1878194.
27.	Joo JY, Park JY, Yoon YH, et al. Prediction of occult central lymph node metastasis in papillary thyroid carcinoma by preoperative BRAF analysis using fine-needle aspiration biopsy: a prospective study. J Clin Endocrinol Metab, 2012, 97(11): 3996-4003.
28.	Choi YJ, Yun JS, Kook SH, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 2010, 34(7): 1494-1499.
29.	Liang K, He L, Dong W, et al. Risk factors of central lymph node metastasis in cN0 papillary thyroid carcinoma: a study of 529 patients. Med Sci Monit, 2014, 20: 807-811.
30.	Ma B, Wang Y, Yang S, et al. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Surg, 2016, 28: 153-161.
31.	Qu H, Sun GR, Liu Y, et al. Clinical risk factors for central lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Clin Endocrinol (Oxf), 2015, 83(1): 124-132.

1. Pellegriti G, Frasca F, Regalbuto C, et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol, 2013, 2013: 965212.
2. Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2): 237-244.
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): 1-133.
4. Kowalski LP, Bagietto R, Lara JR, et al. Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck, 2000, 22(3): 207-214.
5. 中华医学会内分泌学分会, 中华医学会外科学分会, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17): 1249-1272.
6. American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 2009, 19(11): 1153-1158.
7. 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.
8. Pitoia F, Bueno F, Urciuoli C, et al. Outcomes of patients with differentiated thyroid cancer risk-stratified according to the American thyroid association and Latin American thyroid society risk of recurrence classification systems. Thyroid, 2013, 23(11): 1401-1407.
9. Adam MA, Pura J, Goffredo P, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol, 2015, 33(21): 2370-2375.
10. Jeon MJ, Kim WG, Choi YM, et al. Recent changes in the clinical outcome of papillary thyroid carcinoma with cervical lymph node metastasis. J Clin Endocrinol Metab, 2015, 100(9): 3470-3477.
11. Liu FH, Kuo SF, Hsueh C, et al. Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis. J Surg Oncol, 2015, 112(2): 149-154.
12. Zhao W, You L, Hou X, et al. The effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and meta-analysis: pCND for the locoregional recurrence of papillary thyroid cancer. Ann Surg Oncol, 2017, 24(8): 2189-2198.
13. Garcia A, Palmer BJ, Parks NA, et al. Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective. Clin Endocrinol (Oxf), 2014, 81(5): 754-761.
14. Zheng CM, Ji YB, Song CM, et al. Number of metastatic lymph nodes and ratio of metastatic lymph nodes to total number of retrieved lymph nodes are risk factors for recurrence in patients with clinically node negative papillary thyroid carcinoma. Clin Exp Otorhinolaryngol, 2018, 11(1): 58-64.
15. Calò 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(2): 241-248.
16. Kim SK, Woo JW, Lee JH, et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11 569 cases from a single institution. J Am Coll Surg, 2016, 222(5): 853-864.
17. Ji YB, Song CM, Sung ES, et al. Postoperative hypoparathyroidism and the viability of the parathyroid glands during thyroidectomy. Clin Exp Otorhinolaryngol, 2017, 10(3): 265-271.
18. Mao LN, Wang P, Li ZY, et al. Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma. Oncol Lett, 2015, 9(1): 103-107.
19. Lee DY, Oh KH, Cho JG, et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. Int J Endocrinol, 2015, 2015: 571480.
20. Qiao Y, Wang Y, Kang P, et al. The assessment of the accuracy of clinical preoperative lymph node. Medicine (Baltimore), 2019, 98(4): e13778.
21. Jainulabdeen T, Ramaswamy B, Devaraja K, et al. Preoperative staging of differentiated thyroid carcinomas: comparison of USG and CT with intraoperative findings and histopathology. Indian J Otolaryngol Head Neck Surg, 2019, 71(3): 327-333.
22. Suman P, Wang CH, Abadin SS, et al. Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study. Surgery, 2016, 159(1): 31-39.
23. Ahn BH, Kim JR, Jeong HC, et al. Predictive factors of central lymph node metastasis in papillary thyroid carcinoma. Ann Surg Treat Res, 2015, 88(2): 63-68.
24. Soylu L, Aydin OU, Ozbas S, et al. The impact of the multifocality and subtypes of papillary thyroid carcinoma on central compartment lymph node metastasis. Eur Rev Med Pharmacol Sci, 2016, 20(19): 3972-3979.
25. Tang T, Li J, Zheng L, et al. Risk factors of central lymph node metastasis in papillary thyroid carcinoma: a retrospective cohort study. Int J Surg, 2018, 54(Pt A): 129-132.
26. Yan H, Zhou X, Jin H, et al. A study on central lymph node metastasis in 543 CN0 papillary thyroid carcinoma patients. Int J Endocrinol, 2016, 2016: 1878194.
27. Joo JY, Park JY, Yoon YH, et al. Prediction of occult central lymph node metastasis in papillary thyroid carcinoma by preoperative BRAF analysis using fine-needle aspiration biopsy: a prospective study. J Clin Endocrinol Metab, 2012, 97(11): 3996-4003.
28. Choi YJ, Yun JS, Kook SH, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 2010, 34(7): 1494-1499.
29. Liang K, He L, Dong W, et al. Risk factors of central lymph node metastasis in cN0 papillary thyroid carcinoma: a study of 529 patients. Med Sci Monit, 2014, 20: 807-811.
30. Ma B, Wang Y, Yang S, et al. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma: a systematic review and meta-analysis. Int J Surg, 2016, 28: 153-161.
31. Qu H, Sun GR, Liu Y, et al. Clinical risk factors for central lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Clin Endocrinol (Oxf), 2015, 83(1): 124-132.

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Analysis of risk factors for central lymph node metastasis in cN0 papillary thyroid carcinoma

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