Yu Heng1, Zheyu Yang2, Wei Cai3, Lei Tao4, Liang Zhou1, Jianwei Lin2. 1. Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. 2. Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China. 3. Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China. caiwei@shsmu.edu.cn. 4. Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. doctortaolei@163.com.
Abstract
PURPOSE: To effectively predict lateral neck lymph nodes (LLN) metastasis in papillary thyroid carcinoma (PTC) patients with central lymph nodes (CLN) invasion, and devise targeted treatment strategies. METHODS: Four hundred and thirty-four PTC patients with CLN metastasis from two medical centers were retrospectively analyzed. A new statistical model was established for predicting LLN involvement in these patients to guide lymph nodes management strategies. RESULTS: Patients with more than five positive CLN metastasis appeared to have extremely high risk (83.0%) of LLN involvement. For patients with five or less positive CLN invasion, multivariate logistic analyses were applied. Independent risk factors for LLN involvement were determined to be: age over 40, maximum tumor diameter of no less than 1.0 cm, existence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter (iNG). These factors were used to construct a predictive nomogram. The accuracy and validity of our newly built model were verified by C-index 0.761 (95% CI, 0.707-0.815) in development cohort and 0.759 (95% CI, 0.745-0.773) in validation cohort and calibration curve. The patients were stratified into three groups based on their nomogram risk scores. Possible LLN involvement rates for low-risk, moderate-risk, and relatively high-risk subgroups were 8.9%, 22.8%, and 48.2%, respectively. CONCLUSIONS: Our newly established model can effectively predict possible LLN metastasis in PTC patients, and a new strategy selection flow chart was created for patients with positive CLN invasion. For patients in high-risk group, prophylactic LLN dissection is recommended, if not, adjuvant radioactive iodine or a closer follow-up scheme should at least be conducted. For those in low-risk group, surgical intervention is unnecessary and regular follow-up is recommended.
PURPOSE: To effectively predict lateral neck lymph nodes (LLN) metastasis in papillary thyroid carcinoma (PTC) patients with central lymph nodes (CLN) invasion, and devise targeted treatment strategies. METHODS: Four hundred and thirty-four PTCpatients with CLN metastasis from two medical centers were retrospectively analyzed. A new statistical model was established for predicting LLN involvement in these patients to guide lymph nodes management strategies. RESULTS:Patients with more than five positive CLN metastasis appeared to have extremely high risk (83.0%) of LLN involvement. For patients with five or less positive CLN invasion, multivariate logistic analyses were applied. Independent risk factors for LLN involvement were determined to be: age over 40, maximum tumor diameter of no less than 1.0 cm, existence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter (iNG). These factors were used to construct a predictive nomogram. The accuracy and validity of our newly built model were verified by C-index 0.761 (95% CI, 0.707-0.815) in development cohort and 0.759 (95% CI, 0.745-0.773) in validation cohort and calibration curve. The patients were stratified into three groups based on their nomogram risk scores. Possible LLN involvement rates for low-risk, moderate-risk, and relatively high-risk subgroups were 8.9%, 22.8%, and 48.2%, respectively. CONCLUSIONS: Our newly established model can effectively predict possible LLN metastasis in PTCpatients, and a new strategy selection flow chart was created for patients with positive CLN invasion. For patients in high-risk group, prophylactic LLN dissection is recommended, if not, adjuvant radioactive iodine or a closer follow-up scheme should at least be conducted. For those in low-risk group, surgical intervention is unnecessary and regular follow-up is recommended.