| Objective:In recent years,the incidence rate of thyroid micropapillary carcinoma(PTMC)has gradually increased.Although the prognosis is good,some PTMCs may be associated with highly invasive histological types,even with local invasion,lymph nodes and distant metastasis at an early stage,thus facing the risk of recurrence.Studies have shown that lymph node metastasis in the central region is one of the independent risk factors for postoperative recurrence and survival of patients.Domestic and foreign scholars have great controversy on the recommendation of whether to routinely perform preventive dissection for lymph node metastasis in the central region of cN0 PTMC.This study aims to collect clinical data of PTMC,explore the correlation between the central lymph node metastasis and preoperative SII and BRAFv600 e gene positive in patients with cN0 PTMC,as well as the relationship between clinicopathological characteristics and preoperative SII,screen out high-risk central lymph node metastasis factors and patients with worse pathohistological characteristics,provide clinicians with preoperative reference indicators,and avoid unnecessary central lymph node dissection.So as to provide theoretical basis for the clinical formulation of precise and individualized treatment plans.Method:A retrospective analysis was conducted to collect 464 patients who were confirmed as cN0 PTMC and preventive lymph node dissection in the central region by pathology in the nail and breast surgery of Northern People’s Hospital from January2020 to February 2022.They were divided into metastatic group and non-metastatic group according to whether lymph nodes in the central region had metastasis.The clinical characteristic data of cN0 PTMC patients and the NLR(neutrophil count to lymphocyte count ratio),PLR(platelet count to lymphocyte count ratio),MLR(monocyte count to lymphocyte count ratio)and SII {(neutrophil count × The ratio of platelet count to lymphocyte count} was analyzed by univariate analysis,and the data of great significance for univariate analysis were further analyzed by multivariate logistic regression to determine which factors were independent risk factors for lymph node metastasis in the central region.The relationship between SII and BRAFv600 e gene was analyzed according to Pearson correlation,and whether the high SII combined with BRAFv600 e gene mutation group had statistical significance compared with other groups in calculating lymph node metastasis rate in central region.The receiver operating characteristic(ROC)curve was used to evaluate the ability of each detection method in predicting lymph node metastasis in the central region.According to the cutoff value,preoperative SII was divided into high SII group and low SII group,and the relationship between preoperative SII and clinicopathological characteristics of cN0 PTMC patients was explored.Result:1.Of the 464 patients with cN0 PTMC,242 had lymph node metastasis in the central region.It suggests that the rate of occult central lymph node metastasis is relatively high.Univariate analysis of its clinical data shows that gender,BRAFv600 e gene,NLR and SII are independent risk factors for central lymph node metastasis(P<0.05),but there is no significant difference between age,tumor diameter,number of lesions,capsule invasion,TNM stage,TSH,PLR and MLR groups(P<0.05).2.Multivariate analysis showed that gender(OR: 3.21,95% CI: 1.446-6.310,P=0.004),BRAFv600 e gene(OR: 2.77,95% CI: 1.161-6.436,P=0.021),NLR(OR:0.762,95% CI: 0.496-1.062,P=0.099)and SII(OR: 1.006,95% CI: 1.004-1.006,P=0.000).The results showed that sex,BRAFv600 e gene positive and SII were independent risk factors for lymph node metastasis in the central region(P<0.05).3.Pearson correlation analysis showed that there was a positive correlation between SII and BRAFv600 e gene positive,and the correlation coefficient was r=0.479,P<0.001.When cN0 PTMC patients have high SII and BRAFv600 e gene positive at the same time,the probability of central lymph node metastasis in patients is 66.0%,which is significantly higher than the probability of central lymph node metastasis in other groups.After analysis,there is a significant difference between the groups(P<0.001).4.The Yoden index and specificity of preoperative SII combined with BRAFv600 e gene positive diagnosis of central lymph node metastasis in patients with PTMC in cNO stage were better than those of SII or BRAFv600 e gene positive diagnosis alone.The results indicated that preoperative SII combined with BRAFv600 e positive gene had high predictive ability for cervical lymph node metastasis in cN0 PTMC patients.5.According to the ROC curve,the best critical value of SII was obtained,and the best cutoff value of 403 was used as the critical value.The patients were divided into high SII group and low SII group.The univariate analysis of their clinicopathological characteristics showed that the preoperative SII was related to the size of thyroid micropapillary carcinoma,capsule invasion,multifocal,lymph node metastasis and TNM stage(P<0.05),but was related to sex Age was not statistically significant(P>0.05).Logistic multifactor analysis was carried out for the above factors with statistical significance,and the values of gender as female,non-invasion of capsule and non-metastasis of lymph nodes in the central region were 0 respectively.The gender is male,capsule invasion,and lymph node metastasis in the central region are assigned as1.The results showed capsule invasion(OR: 0.287,95% CI 0.048-0.997,P=0.04),multifocal(OR: 8.668,95% CI 2.134-26.454,P=0.01)and lymph node metastasis(OR:2.849,95% CI 1.008-8.087,P=0.047).The results showed that high preoperative SII was related to capsule invasion and multifocal in patients with PTMC at cN0 stage(P<0.05)Conclusion: 1.Gender,BRAFv600 e gene and SII were independent risk factors for predicting lymph node metastasis in the central region.2.Preoperative SII combined with BRAFv600 e gene has a high predictive ability for central lymph node metastasis in patients with cN0 PTMC.3.The patients with cN0 PTMC with high preoperative SII should be highly valued,because the higher preoperative SII may indicate that PTMC has worse pathological and histological characteristics and stronger invasion,which may mean poor prognosis.4.When cN0 PTMC patients have male,preoperative thyroid puncture BRAFv600 e gene positive,SII>403 risk factors,active treatment measures should be taken to carry out preventive central lymph node dissection. |
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