The Clinical Influencing Factors Of Cervical Lymph Node Metastasis In Thyroid Papillary Carcinoma Thyroid:a Meta-analysis

Objective This study investigated the metastatic rule of cervical lymph nodes in thyroid minimal papillary carcinoma(PTMC)and its clinical risk factors,so as to provide a scientific basis for the treatment of PTMC and the risk assessment of metastasis.Methods: PubMed,COCHRANE,MEDLINE,CNKI and other databases were searched for the case-control study literature on risk factors of PTMC cervical lymphatic metastasis published from January 2009 to January 2019,and the RevMan5.3 software was used for statistical analysis.Results:(1)Meta analysis of risk factors for lymph node metastasis in central neck region of thyroid micropapillary carcinoma: Age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion,with calcification,tumor location in the non-upper pole(isthmus and lower pole),the combined effect size OR and 95%CI were0.56[0.43-0.65],1.74[1.47-2.04],0.53[0.47-0.59],2.61[2.28-2.99],1.88[1.56-2.27] 1.57[1.29-1.91],0.75[0.57-0.97].There is statistical significance(P < 0.00001,but the tumor location is located in the upper pole P = 0.03).Therefore,age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion with calcification,tumor location in the non-upper pole(isthmus and lower pole)is associated with lymph node metastasis in the central region of the neck of thyroid micropapillary carcinoma.(2)Meta analysis of risk factors for lymph node metastasis in the lateral neck region of thyroid micro papillary carcinoma: Age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion,tumor location in the upper pole,central region lymph node metastasis,the combined effect size OR and 95%CI were 0.57[0.46-0.71],2.01[1.59-2.53],0.39[0.32-0.48],2.86[2.07-3.94],3.32[2.74-4.03],2.63[1.76-3.94],8.59[4.57-16.14].There is statistical significance(P < 0.00001).Therefore,age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion,tumor location in the upper pole,central area lymph node metastasis is associated with thyroid micro papillary carcinoma lateral cervical area lymph node metastasis.(3)The Meta analysis results of BRAF gene mutation on PTMC cervical lymph node metastasis showed that the combined effect volume was 3.71[1.48-9.27],with statistical significance(P=0.005).BRAF gene mutation was one of the risk factors for cervical lymph node metastasis of thyroid micro papillary carcinoma.Conclusion: Risk factors for lymph node metastasis in the central region of the neck of thyroid micropapillary carcinoma: age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion with calcification,the location of the tumor is not in the upper pole(isthmus and lower pole);Risk factors for lymph node metastasis in the lateral neck region of thyroid micro papillary carcinoma: age <45 years old,male,multifocal,tumor diameter > 5mm,extrapsular invasion,tumor location in the upper pole,central lymph node metastasis;The BRAF gene mutation is one of the risk factors for cervical lymph node metastasis in thyroid micro papillary carcinoma.