Predictive model of neck lateral lymph node metastasis in unilateral papillary thyroid cancer with central lymph node metastasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yi ¹ , MA Yunhan ² , ZHENG Luming ² ,  HE Qingqing ²

1. Jinzhou Medical University, Jinzhou, Liaoning 121000, P. R. China;
2. Department of Thyroid and Breast, The 960th Hospital, PLA Joint Logistics Support Force, Ji’nan 250031, P. R. China;

Corresponding author：

HE Qingqing, Email: heqingqing@yeah.net

Keywords：

unilateral papillary thyroid cancer; central lymph node metastasis; neck lateral lymph node metastasis; prediction model

DOI：

10.7507/1007-9424.202208003

Video：

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Objective To establish a predictive model for neck lateral lymph node metastasis (LLNM) in unilateral papillary thyroid cancer (uni-PTC) with central lymph node metastasis (CLNM). Methods The uni-PTC patients with CLNM were included in this study. The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021, who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3. The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the prediction model. Results A total of 237 patients were included in this study, including 158 patients in the modeling group and 79 patients in the validation group. The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group. The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies. The results showed that the patients with maximum diameter of the lesions >1 cm, multiple lesions, extraglandular invasion, the rate of CLNM ≥0.414, and lesions located at the upper portion had higher probability of LLNM (OR>1, P<0.05). The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834 [95%CI (0.771, 0.896)], which in the validation group was 0.761 [95%CI (0.651, 0.871)]. The calibration curve showed a good calibration degree in the prediction model. Conclusion The clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.

Citation： LI Yi, MA Yunhan, ZHENG Luming, HE Qingqing. Predictive model of neck lateral lymph node metastasis in unilateral papillary thyroid cancer with central lymph node metastasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 60-64. doi: 10.7507/1007-9424.202208003 Copy

1.	Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180. doi: 10.1016/S1470-2045(14)71116-7.
2.	Sywak M, Pasieka JL, McFadden S, et al. Functional results and quality of life after tracheal resection for locally invasive thyroid cancer. Am J Surg, 2003, 185(5): 462-467.
3.	Grubbs EG, Evans DB. Role of lymph node dissection in primary surgery for thyroid cancer. J Natl Compr Canc Netw, 2007, 5(6): 623-630.
4.	秦元, 张浩. 国内外指南中甲状腺癌颈淋巴结清扫手术范围及指征变迁. 中国实用外科杂志, 2020, 40(6): 639-643.
5.	So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg, 2018, 50: 94-103.
6.	Wang Y, Deng C, Shu X, et al. Risk factors and a prediction model of lateral lymph node metastasis in cN0 papillary thyroid carcinoma patients with 1-2 central lymph node metastases. Front Endocrinol (Lausanne), 2021, 12: 716728. doi: 10.3389/fendo.2021.716728.
7.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
8.	贺青卿, 于芳, 范子义, 等. 单中心2 038例甲状腺癌20年随访及危险因素分析. 中华内分泌外科杂志, 2022, 16(1): 18-22.
9.	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.
10.	中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1200.
11.	King JM, Corbitt C, Miller FR. Management of lateral cervical metastases in papillary thyroid cancer: patterns of lymph node distribution. Ear Nose Throat J, 2011, 90(8): 386-389.
12.	Yang Z, Heng Y, Zhao Q, et al. A specific predicting model for screening skip metastasis from patients with negative central lymph nodes metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne), 2021, 12: 743900. doi: 10.3389/fendo.2021.743900.
13.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.
14.	Won HR, Chang JW, Kang YE, et al. Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: a systematic review and meta-analysis. Oral Oncol, 2018, 87: 117-125.
15.	Liu C, Xiao C, Chen J, et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer, 2019, 19(1): 622. doi: 10.1186/s12885-019-5835-6.
16.	Liu S, Liu C, Zhao L, et al. A prediction model incorporating the BRAF^V600E protein status for determining the risk of cervical lateral lymph node metastasis in papillary thyroid cancer patients with central lymph node metastasis. Eur J Surg Oncol, 2021, 47(11): 2774-2780.
17.	Amit M, Boonsripitayanon M, Goepfert RP, et al. Extrathyroidal extension: does strap muscle invasion alone influence recurrence and survival in patients with differentiated thyroid cancer? Ann Surg Oncol, 2018, 25(11): 3380-3388.
18.	Castagna MG, Forleo R, Maino F, et al. Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor. J Endocrinol Invest, 2018, 41(9): 1029-1035.
19.	Dou Y, Hu D, Chen Y, et al. PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis. World J Surg Oncol, 2020, 18(1): 188. doi: 10.1186/s12957-020-01965-x.
20.	Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
21.	Liu Z, Liu Y, Fan Y, et al. Level Ⅱb lymph node metastasis characteristics and predictive factors for patients with cN1b papillary thyroid carcinoma. Surgery, 2020, 167(6): 962-968.
22.	Feng JW, Qin AC, Ye J, et al. Predictive factors for lateral lymph node metastasis and skip metastasis in papillary thyroid carcinoma. Endocr Pathol, 2020, 31(1): 67-76.
23.	江晶晶, 王建华, 丁文波, 等. FNAC联合BRAF^V600E基因检测对甲状腺癌颈部淋巴结转移的诊断价值. 中国普外基础与临床杂志, 2018, 25(9): 1083-1086.
24.	黄美玲, 李永平, 凌瑞. BRAF^V600E基因突变与乳头状甲状腺癌淋巴结转移相关性的Meta分析. 中国肿瘤, 2017, 26(2): 145-151.

1. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180. doi: 10.1016/S1470-2045(14)71116-7.
2. Sywak M, Pasieka JL, McFadden S, et al. Functional results and quality of life after tracheal resection for locally invasive thyroid cancer. Am J Surg, 2003, 185(5): 462-467.
3. Grubbs EG, Evans DB. Role of lymph node dissection in primary surgery for thyroid cancer. J Natl Compr Canc Netw, 2007, 5(6): 623-630.
4. 秦元, 张浩. 国内外指南中甲状腺癌颈淋巴结清扫手术范围及指征变迁. 中国实用外科杂志, 2020, 40(6): 639-643.
5. So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg, 2018, 50: 94-103.
6. Wang Y, Deng C, Shu X, et al. Risk factors and a prediction model of lateral lymph node metastasis in cN0 papillary thyroid carcinoma patients with 1-2 central lymph node metastases. Front Endocrinol (Lausanne), 2021, 12: 716728. doi: 10.3389/fendo.2021.716728.
7. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin, 2021, 71(1): 7-33.
8. 贺青卿, 于芳, 范子义, 等. 单中心2 038例甲状腺癌20年随访及危险因素分析. 中华内分泌外科杂志, 2022, 16(1): 18-22.
9. 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.
10. 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021. 肿瘤预防与治疗, 2021, 34(12): 1164-1200.
11. King JM, Corbitt C, Miller FR. Management of lateral cervical metastases in papillary thyroid cancer: patterns of lymph node distribution. Ear Nose Throat J, 2011, 90(8): 386-389.
12. Yang Z, Heng Y, Zhao Q, et al. A specific predicting model for screening skip metastasis from patients with negative central lymph nodes metastasis in papillary thyroid cancer. Front Endocrinol (Lausanne), 2021, 12: 743900. doi: 10.3389/fendo.2021.743900.
13. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.
14. Won HR, Chang JW, Kang YE, et al. Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: a systematic review and meta-analysis. Oral Oncol, 2018, 87: 117-125.
15. Liu C, Xiao C, Chen J, et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer, 2019, 19(1): 622. doi: 10.1186/s12885-019-5835-6.
16. Liu S, Liu C, Zhao L, et al. A prediction model incorporating the BRAF^V600E protein status for determining the risk of cervical lateral lymph node metastasis in papillary thyroid cancer patients with central lymph node metastasis. Eur J Surg Oncol, 2021, 47(11): 2774-2780.
17. Amit M, Boonsripitayanon M, Goepfert RP, et al. Extrathyroidal extension: does strap muscle invasion alone influence recurrence and survival in patients with differentiated thyroid cancer? Ann Surg Oncol, 2018, 25(11): 3380-3388.
18. Castagna MG, Forleo R, Maino F, et al. Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor. J Endocrinol Invest, 2018, 41(9): 1029-1035.
19. Dou Y, Hu D, Chen Y, et al. PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis. World J Surg Oncol, 2020, 18(1): 188. doi: 10.1186/s12957-020-01965-x.
20. Lee YS, Shin SC, Lim YS, et al. Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer. Head Neck, 2014, 36(6): 887-891.
21. Liu Z, Liu Y, Fan Y, et al. Level Ⅱb lymph node metastasis characteristics and predictive factors for patients with cN1b papillary thyroid carcinoma. Surgery, 2020, 167(6): 962-968.
22. Feng JW, Qin AC, Ye J, et al. Predictive factors for lateral lymph node metastasis and skip metastasis in papillary thyroid carcinoma. Endocr Pathol, 2020, 31(1): 67-76.
23. 江晶晶, 王建华, 丁文波, 等. FNAC联合BRAF^V600E基因检测对甲状腺癌颈部淋巴结转移的诊断价值. 中国普外基础与临床杂志, 2018, 25(9): 1083-1086.
24. 黄美玲, 李永平, 凌瑞. BRAF^V600E基因突变与乳头状甲状腺癌淋巴结转移相关性的Meta分析. 中国肿瘤, 2017, 26(2): 145-151.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Predictive model of neck lateral lymph node metastasis in unilateral papillary thyroid cancer with central lymph node metastasis

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