Predicting occult lymph node metastasis in level II using preoperative factors

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI:10.1016/j.oraloncology.2026.107850

Chengwei Xing , Siyuan Xu , Ruiying Liu , Qiuju Wang , Jie Liu

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引用次数: 0

Abstract

Background

Super-selective neck dissection which declining level II and V for better neck function preservation remains controversial in the treatment of papillary thyroid carcinoma (PTC). This study aims to explore association between occult lymph node metastasis (OLNM) in level II and preoperative clinical characteristics.

Methods

This retrospective study reviewed unilateral cN1b PTC patients who underwent surgery (2000–2017), with clinical lateral neck metastasis limiting in level III and IV. The OLNM in level II was assessed with preoperative clinical characteristics using logistic regression model; its association with pathological nodes distribution was examined with restricted cubic spline; the prognosis value of level II OLNM was evaluated using Kaplan–Meier method and Cox regression model.

Results

A total of 640 patients (mean [SD] age, 41[11.3] years; 440[68.8 %] female individuals; 307[48.0 %] with OLNM in level II) were analyzed. Primary tumor size (>1.5 cm, OR, 1.625[1.174–2.252]; P = 0.003) and clinical positive lymph nodes (multiple, OR, 4.241 [2.283–8.506]; P < 0.001) are associated with elevated risk of level II OLNM. A non-linear relationship was found between level II OLNM and metastatic lymph nodes number in levels III and IV. No significant difference in all-site recurrence-free survival (RFS) or regional RFS was found between patients with or without level II OLNM, even after adjusting other potential risk factors.

Conclusion

The primary tumor size and metastatic burden in adjacent cervical compartments are associated with risk of level II OLNM, super-selective neck dissection could be considered in patients with small primary tumor cancer and low metastatic burden.

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利用术前因素预测II级隐匿淋巴结转移。

背景：在甲状腺乳头状癌（PTC）的治疗中，为了更好地保留颈部功能而降低II级和V级的超选择性颈部清扫术仍然存在争议。本研究旨在探讨II级隐匿淋巴结转移（OLNM）与术前临床特征的关系。方法：本回顾性研究回顾了2000-2017年接受手术的单侧cN1b PTC患者，临床侧颈转移仅限于III级和IV级。II级的OLNM采用logistic回归模型评估术前临床特征；用受限三次样条分析其与病理淋巴结分布的关系；采用Kaplan-Meier法和Cox回归模型评价II级OLNM的预后价值。结果：共分析640例患者（平均[SD]年龄41[11.3]岁，女性440例[68.8%]，II级OLNM 307例[48.0%]）。原发肿瘤大小（>1.5 cm， OR, 1.625[1.174-2.252]; P = 0.003）和临床阳性淋巴结（多个，OR, 4.241 [2.283-8.506]）； P结论：相邻颈间室原发肿瘤大小和转移负担与II级OLNM发生风险相关，原发肿瘤小、转移负担低的患者可考虑超选择性颈部清扫。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.