Risk factors for skip metastasis to lateral cervical lymph nodes in papillary thyroid cancer
Objective:To explore the risk factors associated with skip metastasis to lateral cervical lymph nodes in papillary thyroid carcinoma(PTC),establish a nomogram for predicting the risk of skip metastasis in patients with PTC,and thereby assist in devising a rational surgical plan.Methods:Clinical data from 209 PTC patients who underwent total thyroidectomy and central lymph node dissection(CLND)along with lateral lymph node dissection(LLND)at the First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2021 were collected.The relationship between skip metastasis to lateral cervical lymph nodes and clinical pathological characteristics of the patients,as well as preoperative related examination indicators,were analyzed.The optimal cutoff values for age and ultrasound dominant nodule diameter were identified,and a risk prediction nomogram was constructed.Results:The incidence of skip metastasis to lateral cervical lymph nodes was 12.9%(27/209).Univariate analysis of clinicopathology and preoperative characteristics showed that skip metastasis was significantly associated with age,location of tumor lesion,tumor diameter,number of central lymph nodes dissection,number of lateral cervical lymph node metastasis,diameter of the dominant nodule under ultrasound,ultrasound indications of rough tumor margins,and ultrasound indications of external thyroid invasion(all P<0.05).Multivariate regression analysis showed that age(OR=1.061,P=0.003),the diameter of the nodule under ultrasound(OR=0.874,P=0.003),the location of the tumor in the upper position(OR=2.874,P=0.035),ultrasound-indicated rough tumor margins(OR=0.118,P=0.044),and ultrasound indications of external thyroid invasion(OR=0.287,P=0.013)were independent predictors of skip metastasis to lateral cervical lymph nodes.Age was 38.5 years and the ultrasound nodule diameter was less than 9.5 mm had the greatest predictive value for skip metastasis.Conclusion:PTC patients older than 38.5 years with tumors located in the upper position,ultrasound nodule diameter less than 9.5 mm,rough nodule margins on ultrasound,and ultrasound indications of external thyroid invasion are more likely to experience skip metastasis to lateral cervical lymph nodes.The risk prediction nomogram developed in this study based on these independent risk factors can effectively help clinicians preoperatively assess the risk of skip metastasis in PTC patients.
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