Abstract
Context
More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis
(LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma
(PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing
lobectomy.
Objective
To screen potentially high-risk patients from low-risk patients by using preoperative
and intraoperative clinicopathological features to predict lymph node status.
Methods
A retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009–2021)
was performed according to the 2015 American Thyroid Association (ATA) and 2021 National
Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression
and best subsets regression were used to identify risk factors. Nomograms were established
and externally validated using the Differentiated Thyroid Cancer in China cohort.
Results
More than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models
containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node
(all p < 0.05) were established. The nomogram based on NCCN criteria showed better
discriminative power and consistency with a specificity of 0.706 and a sensitivity
of 0.725, and external validation indicated that 76% of potentially high-risk patients
could achieve preoperative conversion of surgical strategy.
Conclusions
Models based on large cohorts with good predictive performance were constructed and
validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years,
male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM
or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce
CTx.
Keywords
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Article info
Publication history
Published online: April 01, 2023
Accepted:
March 31,
2023
Received in revised form:
March 27,
2023
Received:
September 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd.
