Chunhao Liu1, Yuewu Liu1, Lei Zhang2, Yunwei Dong3, Shenbao Hu4, Yu Xia5, Bo Zhang5, Yue Cao1, Ziwen Liu1, Ge Chen1, Zhonghua Shang6, Jinbao Yang7, Qinghe Sun8, Xiaoyi Li1. 1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. 2. Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. 3. Department of General Surgery, Xinzhou People's Hospital, Xinzhou 034000, China. 4. Department of General Surgery, Jingmen First People's Hospital, Jingmen 448000, China. 5. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. 6. Department of General Surgery, Second Hospital of Shanxi Medical University, Taiyuan 030001, China. 7. Department of General Surgery, People's Liberation Army Bethune International Peace Hospital, Shijiazhuang 050082, China. 8. Department of General Surgery, Cangzhou People's Hospital, Cangzhou 061000, China.
Abstract
BACKGROUND: Lymph node metastasis (LNM) often occurs in clinical lymph node negative (cN0) papillary thyroid microcarcinoma (PTMC). The risk factors for LNM, especially for high-volume LNM, were investigated in this study. METHODS: The medical records of 1,974 consecutive PTMC patients admitted to the Peking Union Medical College Hospital (PUMCH) from 2013 to 2015 were reviewed. Their clinicopathological features were collected. Univariate and multivariate analyses were performed to identify the risk factors for LNM/high-volume LNM. RESULTS: Of all the patients, cervical lymph node metastases were detected in 690 patients (34.95%), and high-volume LNM was detected in 75 patients (3.80%). The results of univariate analysis revealed that sex, age, chronic thyroiditis, multifocality, and tumor diameter were significantly correlated with LNM (P<0.05) and that sex, age, multifocality, and tumor diameter were significantly correlated with high-volume LNM (P<0.05). Multivariate logistic regression analysis demonstrated that male sex [odds ratio (OR) =1.657, P<0.001], multifocality (OR =1.601, P<0.001), and tumor diameter >0.5 cm (OR =1.770, P<0.001) were independent risk factors for LNM; age of 40-59 years old (OR =0.427, P<0.001), age ≥60 years old (OR =0.291, P<0.001), and chronic thyroiditis (OR =0.562, P<0.001) were independent protective factors for LNM. For high-volume LNM, male sex (OR =2.250, P=0.002), tumor diameter >0.5 cm (OR =3.664, P=0.013) and multifocality (OR =2.034, P=0.004) were independent risk factors, whereas age ≥40 years old (OR =0.240, P<0.001) was an independent protective factor. CONCLUSIONS: Lymph node metastases are common in cN0 PTMC, whereas high-volume LNM is rare. Active surveillance may be reasonable for patients with tumor diameter ≤0.5 cm, age ≥40 years old, female sex and isolated lesions. 2019 Gland Surgery. All rights reserved.
BACKGROUND: Lymph node metastasis (LNM) often occurs in clinical lymph node negative (cN0) papillary thyroid microcarcinoma (PTMC). The risk factors for LNM, especially for high-volume LNM, were investigated in this study. METHODS: The medical records of 1,974 consecutive PTMC patients admitted to the Peking Union Medical College Hospital (PUMCH) from 2013 to 2015 were reviewed. Their clinicopathological features were collected. Univariate and multivariate analyses were performed to identify the risk factors for LNM/high-volume LNM. RESULTS: Of all the patients, cervical lymph node metastases were detected in 690 patients (34.95%), and high-volume LNM was detected in 75 patients (3.80%). The results of univariate analysis revealed that sex, age, chronic thyroiditis, multifocality, and tumor diameter were significantly correlated with LNM (P<0.05) and that sex, age, multifocality, and tumor diameter were significantly correlated with high-volume LNM (P<0.05). Multivariate logistic regression analysis demonstrated that male sex [odds ratio (OR) =1.657, P<0.001], multifocality (OR =1.601, P<0.001), and tumor diameter >0.5 cm (OR =1.770, P<0.001) were independent risk factors for LNM; age of 40-59 years old (OR =0.427, P<0.001), age ≥60 years old (OR =0.291, P<0.001), and chronic thyroiditis (OR =0.562, P<0.001) were independent protective factors for LNM. For high-volume LNM, male sex (OR =2.250, P=0.002), tumor diameter >0.5 cm (OR =3.664, P=0.013) and multifocality (OR =2.034, P=0.004) were independent risk factors, whereas age ≥40 years old (OR =0.240, P<0.001) was an independent protective factor. CONCLUSIONS: Lymph node metastases are common in cN0 PTMC, whereas high-volume LNM is rare. Active surveillance may be reasonable for patients with tumor diameter ≤0.5 cm, age ≥40 years old, female sex and isolated lesions. 2019 Gland Surgery. All rights reserved.
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