Analysis The Risk Factors Of Cervical Lymph Nodes Metastasis In Papillary Thyroid Macrocarcinoma

Background and ObjectiveThe risk factors for lymph nodes metastasis were analyzed on patients with papillary thyroid macrocarcinoma.Predicted models were developed to predict the probability of the lymph nodes metastasis.MethodsRetrospective analysis was conducted to analyze the clinical data of papillary thyroid carcinoma patients undergoing surgical treatment and confirmed by postoperative pathology in the Department of Thyroid Surgery,First Affiliated Hospital of Zhengzhou University from June 2014 to June 2018.T-tests,?2-test and Rank sum test were performed to compare the clinical characteristics.Multivariate Logistic regression analyses were conducted to estimate the risk factors of the lymph node metastasis on papillary thyroid macrocarcinoma.Nomogrames were developed to make the prediction visualized.The outcomes of AUC and Hosmer-Lemeshow goodness of fit test were shown to analyze the discrimination and calibration of the two models.The ROC curves as well as calibration curves were described to make test visualized.ResultsA total of 487 cases with papillary thyroid macrocarcinoma were collected.296(60.8%)patients with central lymph node metastasis and 173 cases(35.5%)with lateral lymph node metastasis were retrospectively analyzed.As for central lymph node metastasis,there existed without difference on the BrafV600 E gene,diameter,multifocality,bilaterality and the subtype of the pathology(P>0.05),but the patients who were younger,male,infiltrative tumor margin,extrathyroidal extension and coexisting with Hashimoto's thyroiditis were more likely to have central lymph node metastasis(P<0.05).As for lateral lymph node metastasis,there existed without significant difference on gender,multifocality and pathological subtypes of tumor(P>0.05).But the patients who were younger,increasing tumor diameter,BrafV600 E gene mutation,bilaterality,infiltrative tumor margin,extrathyroidal extension and coexisting with Hashimoto's thyroiditis tended to have lateral lymph node metastasis(P<0.05).Multivariate Logistic regression analysis of lymph node metastasis for papillary thyroid macrocarcinoma patients showed that coexisting with Hashimoto's thyroiditis,male,increasing age and extrathyroidal extension were the risk factors for the central lymph node.Extrathyroidal extension,bilaterality and central lymph node metastasis were risk factors for lateral lymph node metastasis,while BrafV600 E gene mutation and increasing age were protective factors for lateral lymph node metastasis.Nomograms were developed in the study to predict the risk of the lymph node metastasis visualized according to multivariate Logistic regression models.After analyzing the discrimination and calibration of the two models,the AUCs of the two models were 0.68 and 0.82,and the Hosmer-Lemeshow good of fit test of these were 0.794 and 0.726.ConclusionsAccording to multivariate Logistic regression analyses and development of prediction models,it is notable that coexisting with Hashimoto,male,extrathyroidal extension and decreasing age were risk factors for central lymph node metastasis in papillary thyroid macrocarcinoma.The extrathyroidal extension,bilaterality,central lymph node metastasis,BrafV600 E gene wide type and decreasing age were the risk factors for the lateral lymph node metastasis on papillary thyroid macrocarcinoma patients.Nomograms made the predictions precise and decreased the risk of the reoperation for individuals,which were user-friendly.