Retrospective Study Of Patients With Papillary Thyroid Microcarcinoma And Establishment Of A Nomogram Model For Predicting Central Lymph Node Metastasis

Purpose To analyze the clinical features of patients with papillary thyroid microcarcinoma(PTMC)and to study the related factors connected with central lymph node metastasis(CLNM).Then,to design a nomogram for predicting CLNM;To analyze the clinical features of papillary thyroid carcinoma(PTC)patients with diameter greater than 1cm,and to study the risk factors of lateral lymph node metastasis.Methods The clinical characteristics of 1391 PTC patients who were initially treated in our hospital from January 2016 to December 2017 were retrospectively analyzed.The chi-square test and the binomial logistic regression model were used to predict the risk factors of CLNM in PTC(602 cases)with a diameter of 1 cm or less.The factors had significance in the final logistic regression model were built into a nomogram to guide clinical decision.A similar statistical method was used to evaluate the factors of lateral lymph node metastasis in PTC(789 cases)with a diameter greater than 1 cm.Results In patients with D?1cm,univariate analysis showed that the gender,age,the largest diameter of tumor,tumor lesions in bilateral lobes,multifocal lesions and lateral lymph node metastasis(LLNM)were closely associated with CLNM in PTMC.Binary logistic regression multivariate analysis further indicated that male,age <45years,tumor diameter >5 mm,and LLNM were independent risk factors for CLNM in PTMC.In patients with D>1cm,age less than 45 years and CLNM were independent risk factors for LLNM in patients,and when the number of lymph node metastases in the central region was greater than or equal to 3,the risk of LLNM was significantly increased.Conclusion It is necessary to keep a wary eye on the possibility of lymph node metastasis in the central region of PTMC patients.Central lymph node dissection is recommended for PTMC patients with male gender,age <45 years old,maximum tumor diameter >5mm and LLNM.The nomogram based on the risk variables which has a certain accuracy of 0.710 may help guide surgical decision making in PTMC.For patients whose tumor diameters are greater than 1 cm in diameter,if the patient is younger than 45 years with CLNM and the number of metastatic lymph node is greater than or equal to 3,the risk of LLNM is increased.