Clinical And Pathologic Predictors Of Lateral Cervical Lymph Node Metastasis In Medullary Thyroid Carcinoma

Objective:To explore the clinical and pathologic predictors of metastatic lymph node cancer in medullary thyroid carcinoma(MTC),and to develop a more suitable surgical treatment plan for patients in the clinical.Methods:Through retrospective analysis,the data were collected from 61 patients whose postoperative pathological diagnosis were medullary thyroid carcinoma after operative surgery from January 2013 to July 2018 in Dalian Medical University Second Affiliated Hospital Thyroid Surgery.There are 35 patients,preoperative imaging showed no evidence of metastasis of lymph node carcinoma in the lateral cervical region,and another 26 patients’ preoperative imaging and biopsy suggested the presence of lymph node metastasis in the lateral cervical region.By comparison about the age,sex,tumor diameter,presence or absence of thyroid capsule invasion,presence or absence of extrthyroid tissue invasion,multiple tumor lesions,double-lobed tumor lesions,preoperative calcitonin levels,preoperative CEA levels,postoperative central lymph node metastasis and postoperative immunohistochemistry,in order to investigate the influencing factors of lateral cervical lymph node metastasis of medullary thyroid carcinoma and the clinical significance of prophylactic lateral neck lymph node dissection for medullary thyroid carcinoma.Results:By using categorical and continuous variables analysis of clinical and pathological data of 61 patients with MTC,thyroid capsule invasion,tumor diameter,central lymph node metastasis,preoperative serum calcitonin level and preoperative carcinoembryonic antigen levels were compared between these two groups of patients.There were significant differences in clinical and pathological features(p<0.05).Logistic regression analysis of statistically significant differences in categorical variables revealed that thyroid capsule invasion,tumor diameter(>2.0 cm),and postoperative central lymph node metastasis(>3)were significantly correlated with lymph node metastasis in the neck region of MTC(P<0.05).Preoperative serum CT values and serum CEA values with statistically significant differences in continuous variables were included in the ROC curve,and the best cut-off value was found to be serum calcitonin level >289 pg/ml and preoperative carcinoembryonic antigen >22ng/ml.Conclusion:Analysis of influencing factors of clinical MTC lateral cervical lymph node metastasis: tumor diameter(>2.0cm),pathological thyroid capsule invasion,positive lymph node metastasis in central area(>3),preoperative serum calcitonin>289pg/ml,The preoperative carcinoembryonic antigen was >22 ng/ml.The above variables mentioned are high-risk factors in the metastasis of the cervical cancer of the MTC side.It is recommended that patients with high risk factors in the clinical stage undergo a total thyroidectomy and central lymph node dissection,and additional prophylactic lateral neck lymph node dissection.