Risk stratification for central lymph node metastasis in mono-focal papillary thyroid carcinoma patients with encapsulated tumor as confirmed by preoperative ultrasound: a multi-center analysis.

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2024-12-01 Epub Date: 2024-07-25 DOI:10.1007/s12020-024-03861-w

Yangyang Ji, Yu Heng, Zhenwei Wang, Wei Cai, Chunping Wu, Zheyu Yang, Lei Tao

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引用次数: 0

Abstract

Purposes: Mono-focal papillary thyroid carcinoma (PTC) patients with encapsulated tumor have traditionally been considered as low central lymph node metastasis (CLNM) risk subgroup. The aim of the research was to quantitatively predict the probability of CLNM for mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound based on pre- and post-operative indexes respectively to guide the selection of prophylactic central lymph node dissection (CLND) and follow-up strategies.

Methods: A total of 1014 mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound from three medical centers were retrospectively analyzed, with 534 patients served as Training group and 480 patients as Validation group.

Results: Multivariate analyses showed that age < 55 years old, male, clinical maximum tumor diameter (cMTD) > 0.5 cm, pathological maximum tumor diameter (pMTD) > 0.5 cm, and the presence of microscopic thyroid capsular invasion (mTCI) were independent CLNM risk factors. These were used to construct two nomograms that can effectively predict the central neck involvement in mono-focal PTC patients with encapsulated tumor. The first nomogram (pre-model) provides quantitative assessment on the necessity of prophylactic CLND, while the second nomogram (post-model) informs postoperative follow-up strategies.

Conclusions: Meticulous and comprehensive stratification flow charts that quantitatively evaluate the risk of central lymph node metastasis both pre- and post-operatively were constructed for mono-focal PTC patients with encapsulated tumor as confirmed by preoperative ultrasound, which may benefit both clinical decision-making of prophylactic CLND and postoperative follow-up strategies for the management of neck regions.

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经术前超声确认为包裹性肿瘤的单灶甲状腺乳头状癌患者中央淋巴结转移的风险分层：一项多中心分析。

目的：具有包裹性肿瘤的单灶甲状腺乳头状癌（PTC）患者历来被认为是中央淋巴结转移（CLNM）的低风险亚组。该研究旨在根据术前和术后指标，分别定量预测经术前超声证实为包膜瘤的单灶甲状腺乳头状癌患者发生CLNM的概率，以指导预防性中央淋巴结清扫术（CLND）和随访策略的选择：回顾性分析了来自三个医疗中心的1014例经术前超声检查确诊为包裹性肿瘤的单灶PTC患者，其中534例患者为训练组，480例患者为验证组：多变量分析表明，年龄 0.5 厘米、肿瘤病理最大直径（pMTD）> 0.5 厘米和存在甲状腺囊显微侵犯（mTCI）是独立的 CLNM 危险因素。利用这些因素构建了两个提名图，可以有效预测单灶PTC包膜瘤患者的颈部中央受累情况。第一个提名图（前模型）可对预防性 CLND 的必要性进行量化评估，而第二个提名图（后模型）可为术后随访策略提供参考：结论：针对术前超声检查确认为包膜瘤的单灶 PTC 患者，构建了缜密而全面的分层流程图，可定量评估术前和术后中央淋巴结转移的风险，这可能有利于预防性 CLND 的临床决策和颈部区域管理的术后随访策略。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.