P-194 Risk factors for central lymph node metastases in patients with cN0 papillary microcarcinoma: An analysis of 306 patients at a single institution

The health problems caused by the frequent relapse of papillary thyroid carcinoma (PTC) remain a worldwide concern since the morbidity rate of PTC ranks the highest among thyroid cancers. Residues from contralateral central lymph node metastases (con-CLNM) are the key reason for persistence or recurrence of unilateral papillary thyroid carcinoma (uni-PTC); however, the ability to assess the status of con-CLNM in uni-PTC patients is limited. To clarify the risk factors of con-CLNM, a total of 250 patients with uni-PTC who underwent total thyroidectomy and bilateral central lymph node dissection were recruited in this study. We compared the clinical, sonographic, and pathological characteristics of patients with con-CLNM to those without con-CLNM and established a nomogram for con-CLNM in uni-PTC. We found that male sex, without Hashimoto’s thyroiditis, present capsular invasion, with ipsilateral lateral lymph node metastases, and the ratio of ipsilateral central lymph node metastases ≥0.16 were independent con-CLNM predictors of uni-PTC (ORs: 2.797, 0.430, 2.538, 2.202, and 26.588; 95% CIs: 1.182–6.617, 0.211–0.876, 1.223–5.267, 1.064–4.557, and 7.596–93.069, respectively). Additionally, a preoperative nomogram for the prediction of con-CLNM based on these risk factors showed good discrimination (C-index 0.881; 95% CI: 0.840–0.923; sensitivity 85.3%; specificity 76.0%) and good agreement via the calibration plot. Our study provided a way to quantitatively and accurately predict whether con-CLNM occurred in patients with uni-PTC, which may guide surgeons to evaluate the nodal status and perform tailored therapeutic central lymph node dissection.

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Multifocal Papillary Thyroid Carcinoma，Hashimoto's Thyroiditis and Lymph Node Metastasis：A Retrospective Cohort Study

10.21203/rs.3.rs-194311/v1 ◽

2021 ◽

Author(s):

Denghui Wang ◽

Jiang Zhu ◽

Chang Deng ◽

Zhixin Yang ◽

Daixing Hu ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Protective Factor ◽

Roc Curves ◽

Multivariate Logistic Regression ◽

Lateral Lymph Node ◽

Node Metastases ◽

Independent Risk Factors ◽

Central Lymph

Abstract Objective: Few studies have evaluated the influence of HT and Multifocality on central lymph node metastases(CLNM) and lateral lymph node metastases(LLNM) of PTC. The present study focused on risk factors for lymph node metastasis in PTC according to the presence of HT or multifocality. Materials and methods:1413 patients were identified.The relationship between HT or multifocality and lymph nodemetastasis was analyzed by univariate and multivariate logistic regression, ROC curves were constructed to show the predictive effect of each variable on the target outcome.Results: The PTCs with HT were more likely to be multifocal.(40.0% versus 17.5%,P ＜0.001). Compared to MPTC without HT, MPTC with HT showed a lower number of metastatic CLNs and LLNs (P < 0.05). HT was identifified as an independent protective factor for CLNM in all PTC patients (OR, 0.480; 95% CI, 0.359-0.643; P< .001) and in MPTC patients (OR, 0.094; 95% CI, 0.044-0.204; P < 0.001), the multicocality was independent risk factors for CLNM(OR, 2.316; 95% CI, 1.667-3.217; P< 0.001) and LLNM(OR, 2.004; 95% CI, 1.469-2.733; P< 0.001).The variables concluded HT or MPTC were screened to predict CLNM in all patients, CLNM in patients with MPTC and LLNM in all patients (AUCs: 0.731, 0.843 and 0.696, respectively, P < 0.0001). The two type of diseases existed concurrently may result in the decrease of CLNM and LLNM, AUCs of ROC to predict CLNM and LLNM are 0.696 and 0.63(P<0.0001). Conclusions: Our study identified multifocality as an independent risk factor predicting CLNM and LLNM in PTC patients. HT was proven to be a protective factor that reduced the CLNM risk in all patients and in patients with MPTC. The existence of both type of diseases can result in the reduction of CLNM and LLNM.

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Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma

Gland Surgery ◽

10.21037/gs.2020.03.27 ◽

2020 ◽

Vol 9 (3) ◽

pp. 695-701

Author(s):

Xin Wu ◽

Binglu Li ◽

Chaoji Zheng ◽

Xiaodong He

Keyword(s):

Lymph Node ◽

Lymph Node Metastases ◽

Papillary Thyroid Microcarcinoma ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Thyroid Microcarcinoma ◽

Predicting Factors ◽

Node Metastases ◽

Central Lymph

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Risk Factors and a Prediction Model of Lateral Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma Patients With 1–2 Central Lymph Node Metastases

Frontiers in Endocrinology ◽

10.3389/fendo.2021.716728 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yuanyuan Wang ◽

Chang Deng ◽

Xiujie Shu ◽

Ping Yu ◽

Huaqiang Wang ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lateral Lymph Node Metastasis ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Lateral Lymph Node ◽

Node Metastasis ◽

Node Metastases ◽

Central Lymph

BackgroundPapillary thyroid cancer (PTC) in clinically lymph node-negative (cN0) patients is prone toward lymph node metastasis. As a risk factor for tumor persistence and local recurrence, lateral lymph node metastasis (LLNM) is related to the number of central lymph node metastases (CLNMs).MethodsWe performed LLNM risk stratification based on the number of CLNMs for cN0 PTC patients who underwent thyroidectomy and lymph node dissection between January 2013 and December 2018. A retrospective analysis was applied to the 274 collected patients with 1-2 CLNMs. We examined the clinicopathological characteristics of the patients and constructed a LASSO model.ResultsIn the 1–2 CLNM group, tumors >10 mm located in the upper region and nodular goiters were independent risk factors for LLNM. Specifically, tumors >20 mm and located in the upper region contributed to metastasis risk at level II. Hashimoto’s thyroiditis reduced this risk (p = 0.045, OR = 0.280). Age ≤ 30 years and calcification (microcalcification within thyroid nodules) correlated with LLNM. The LASSO model divided the population into low- (25.74%) and high-risk (57.25%) groups for LLNM, with an AUC of 0.715.ConclusionsFor patients with 1–2 CLNMs, young age, calcification, nodular goiter, tumor >10 mm, and tumor in the upper region should alert clinicians to considering a higher occult LLNM burden. Close follow-up and therapy adjustment may be warranted for high-risk patients.

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Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

Cancers ◽

10.3390/cancers13236028 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6028

Author(s):

Marta Tagliabue ◽

Gioacchino Giugliano ◽

Maria Cecilia Mariani ◽

Manila Rubino ◽

Enrica Grosso ◽

...

Keyword(s):

Multivariate Analysis ◽

Lymph Node ◽

Lymph Node Metastases ◽

Binary Logistic Regression ◽

Central Compartment ◽

Good Prognosis ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Node Metastases ◽

Central Lymph

Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.

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