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Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis

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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.

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Acknowledgements

This study was supported by the Science and Technology Innovation Project of Shanghai Shenkang Hospital Clinical Development Center under Grand [SHDC12015114]; the Science and Technology Commission of Shanghai Municipality under Grand [16411950100]; the National Natural Science Foundation of China under Grand [81772878, 30801283, 30972691]; the Shanghai Science and Technology Development Funds under Grand [09QA1401000, 10QA1405900, 14411961900]; the Training Program of the Excellent Young Talents of Shanghai Municipal Health System under Grand [XYQ2011055, XYQ2011015]; and the Shanghai Municipal Science and Technology Foundation under Grand [11JC1410802].

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Y.H., Z.Y., L.T., and W.C. The first draft of the paper was written by Y.H. and Z.Y., and all authors commented on previous versions of the paper. All authors read and approved the final paper.

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Author notes

  1. These authors contributed equally: Yu Heng, Zheyu Yang

  2. These authors contributed equally: Lei Tao, Wei Cai

Authors and Affiliations

  1. Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China

    Yu Heng, Liang Zhou & Lei Tao

  2. Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China

    Zheyu Yang, Jianwei Lin & Wei Cai

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  1. Yu Heng
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  2. Zheyu Yang
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  3. Liang Zhou
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  5. Wei Cai
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  6. Lei Tao
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Correspondence to Wei Cai or Lei Tao.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Ethics Committee of the Eye and ENT Hospital of Fudan University and the Ruijin Hospital of Shanghai Jiao Tong University School of Medicine, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Heng, Y., Yang, Z., Zhou, L. et al. Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis. Endocrine 68, 320–328 (2020). https://doi.org/10.1007/s12020-020-02194-8

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