Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes (Cont-CLNs) in unilateral near isthmus papillary thyroid carcinoma (PTC), and to establish a prediction model of lymph node metastasis, so as to provide reference for the scope of lymph node dissection. Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital, and according to the location of the cancer, they were divided into the isthmus group (n=152) and the unilateral glandular lobe group (n=229) , and the correlation analysis was performed on whether there was Cont-CLNs metastasis. One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred. Univariate analysis was used to analyze the relationship between gender, age, distribution of glandular lobe, tumor size, tumor location, pathological subtype, capsule invasion, thyroid stimulating hormone (TSH) level, combine Hashimoto’s thyroiditis (HT), ipsilateral central lymph nodes（Ipsi-CLNs) metastasis and Cont-CLNs metastasis. According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures, they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model. Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group (24.3% vs. 14.4%, χ²=6.009, P=0.014). Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age (P=0.02), tumor size (P＜0.01), capsule invasion (P＜0.01) and Ipsi-CLNs metastasis (P＜0.01), but not with gender, distribution of glandular lobe, tumor location, pathological subtype, TSH level and whether to merge HT (P＞0.05). Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC. Moreover, the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow. Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC. It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.
ObjectiveTo investigate the predictive value of pretracheal lymph node (Ⅵc) subdivision for contralateral central lymph node (CLN) metastasis in clinical lymph node negative (cN0) unilateral papillary thyroid carcinoma (PTC). MethodsThe data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July 2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea (Ⅵc1) and left anterior trachea (Ⅵc2); If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. ResultsA total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal (Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54 cases (30.9%), 118 cases (67.4%), 85 cases (48.6%), 72 cases (41.1%), 108 cases (61.7%), and 43 cases (24.6%), respectively. The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions; The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis (OR=4.444, P<0.001; OR=6.655, P=0.001). ConclusionsFrom the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
ObjectiveTo investigate the risk factors affecting cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). MethodsThe patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors affecting the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally, the discriminatory power of the predictive model for CLNM or LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). ResultsA total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old, and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral or isthmus distribution of cancer foci, maximum tumor diameter >5 mm, and invasion of capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, distribution of cancer foci, maximum tumor diameter, and capsular invasion], the AUC (95%CI) was 0.776 (0.707, 0.846). ConclusionsThe findings of this study suggest that younger male patients with PTC (age <36 years), and a maximum tumor diameter >5 mm have a higher risk of CLNM. However, the predictive model constructed for CLNM demonstrates only moderate discriminatory power. In contrast, elderly patients (age ≥59 years old) with PTC exhibiting a maximum tumor diameter >5 mm, capsular invasion, and bilateral (or isthmus) lesions are at greater risk of LLNM. The predictive model developed for LLNM shows a certain discriminatory performance.
Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma (PTMC). Methods PTMC patients who underwent surgical operations in West China Hospital, Sichuan University between January 2014 and December 2018 were retrospectively enrolled. The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound. During the operation, the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck. With postoperative pathology as the gold standard, patients were divided into central cervical lymph node micrometastasis group (micrometastasis group) and central cervical lymph node non-metastasis group (non-metastasis group). The differences of clinical features and ultrasonic signs between the two groups were analyzed. Results A total of 507 patients were included, including 223 (44.0%) in the micrometastasis group and 284(56.0%) in the non-metastasis group. The results of univariate analysis showed that compared with the non-metastasis group, the patients in the micrometastasis group were younger, the tumor size were higher, the proportion of male, multifocality, bilateral involvement and thyroid capsular invasion were higher. The results of multiple logistic regression analysis showed that lower age [odds radio (OR)=0.967, 95% confidence interval (CI)(0.949, 0.985), P<0.001], male [OR=2.357, 95%CI (1.503, 3.694), P<0.001)], a larger maximum diameter of PTMC [OR=1.232, 95%CI (1.100, 1.379), P<0.001], a larger nodule volume of PTMC [OR=1.031, 95%CI (1.008, 1.114), P=0.032], multifocal lesion [OR=2.309, 95%CI (1.167, 4.570), P=0.016] and invasion of the thyroid capsule [OR=1.520, 95%CI (1.010, 2.286), P=0.045] were independent risk factors for central cervical lymph node micrometastasis. Conclusions The patient’s male, young age, PTMC nodule with large maximum diameter and large volume, multifocal, and invasion of the thyroid membrane are risk factors for the central cervical lymph node micrometastasis of PMTC patients. These clinical and ultrasound signs can provide a theoretical basis for doctors’ clinical management decisions.
ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
ObjectiveTo investigate the effects of thyroid globulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) statuses on central lymph node (CLN) metastasis in patients with differentiated thyroid cancer (DTC).MethodsA retrospective analysis was performed on 526 patients with DTC confirmed by pathology from nine participating institutions, who underwent the bilateral thyroidectomy plus bilateral CLN dissection. The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared, and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.ResultsAll of 526 patients with DTC were included in this study, 152 were males and 374 were females. The age was (44±11) years old. There were 63 cases of TgAb＋TPOAb＋, 60 cases of TgAb＋TPOAb－, 30 cases of TgAb－TPOAb＋, and 373 cases of TgAb－TPOAb－. It was found that there was a significant difference in the gender among the four different antibody statuses of patients, that was, women with abnormal antibodies were more common (P<0.001), not found that there were related to the tumor size, blood vessel invasion, nerve invasion, CLN metastasis, tumor multifocality, and bilateral tumor or not (P>0.050). In this study, there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis. The results of multivariate analysis found that the age and gender of the patients were the independent risk factors (P<0.001), but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis (P>0.050).ConclusionsStatuses of TGAb and TPOAb aren’t obviously associated with CLN metastasis in patients with DTC, which is inconsistent with other studies. It needs to be further researched after expanding existing sample size and determining new predictive factors.
ObjectiveTo investigate the effect of lymph node dissection in central region on the prognosis of cN0 papillary thyroid microcarcinoma (PTMC).MethodsAccording to the inclusion and exclusion criteria, 300 patients with cN0 PTMC underwent operation in the Second Department of General Surgery of Zhongshan People’s Hospital from January 1, 2007 to May 31, 2016 were retrospectively collected, then who were divided into the central lymph node non-dissection (147 cases) and dissection (153 cases) groups according to whether central lymph node dissection or not. The differences in the incidence of postoperative complications, recurrence rate, and metastasis rate between the two groups were analyzed. The risk factors of central lymph node metastasis of cN0 PTMC were analyzed.ResultsAll patients had no postoperative lymphatic leakage and death. Fifty-nine (38.6%) cases had the lymph node metastasis in the patients with central lymph node dissection. The patients were followed up for (83.0±20.7) months and (79.5±26.2) months (t=1.283, P=0.203) of the non-dissection group (147 cases) and dissection group (153 cases), respectively. During the follow-up period, there was no distant metastasis such as bone metastasis and lung metastasis in both groups; 5 cases recurred in the non-dissection group, 1 case recurred in the dissection group, and there was no significant difference in the recurrence rate between the two groups (χ2=3.008, P=0.089). There was no permanent complications between the two groups. There was no significant difference in the disease-free survival curve (χ2=2.565, P=0.109) between the two groups. The incidence of capsule invasion (P=0.026), calcification (P<0.001), hoarseness (P=0.013), numbness of limbs (P<0.001) in the dissection group were significantly higher than those in the non-dissection group. The results of multivariate analysis showed that the multifocal (OR=24.57, P<0.001), tumor diameter >5 mm (OR=5.46, P=0.019), and capsule invasion (OR=9.42, P=0.002) were the independent risk factors for the lymph node metastasis in the central region.ConclusionsFrom the results of the study, thyroidectomy alone is safe for cN0 PTMC, but the changes of lymph nodes in the central region still need more long-term follow-up. cN0 PTMC patients with tumor diameter >5 mm, multifocal, and capsule invasion are more likely to have lymph node metastasis in the central region. Comprehensive evaluation can be made according to the patient’s condition, and individualized and precise treatment can be carried out.