Purpose

Papillary thyroid microcarcinoma (PTMC) frequently presents a favorable clinical outcome, while aggressive invasiveness can also be found in some of this population. Identifying the risk clinical factors of high-volume (> 5) central lymph node metastasis (CLNM) in PTMC patients could help oncologists make a better-individualized clinical decision.

Methods

We retrospectively reviewed the clinical characteristics of adult patients with PTC in the Surveillance, Epidemiology, and End Results (SEER) database between Jan 2010 and Dec 2015 and in one medical center affiliated to Chongqing Medical University between Jan 2018 and Oct 2020. Univariate and multivariate logistic regression analyses were used to determine the risk factors for high volume of CLNM in PTMC patients.

Results

The male gender (OR = 2.02, 95% CI 1.46–2.81), larger tumor size (> 5 mm, OR = 1.64, 95% CI 1.13–2.38), multifocality (OR = 1.87, 95% CI 1.40–2.51), and extrathyroidal invasion (OR = 3.67; 95% CI 2.64–5.10) were independent risk factors in promoting high-volume of CLNM in PTMC patients. By contrast, elderly age (≥ 55 years) at diagnosis (OR = 0.57, 95% CI 0.40–0.81) and PTMC-follicular variate (OR = 0.60, 95% CI 0.42–0.87) were determined as the protective factors. Based on these indicators, a nomogram was further constructed with a good concordance index (C-index) of 0.702, supported by an external validating cohort with a promising C-index of 0.811.

Conclusion

A nomogram was successfully established and validated with six clinical indicators. This model could help surgeons to make a better-individualized clinical decision on the management of PTMC patients, especially in terms of whether prophylactic central lymph node dissection and postoperative radiotherapy should be warranted.

中文翻译：

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用于预测甲状腺微小乳头状癌大体积（> 5）中央淋巴结转移的个体化列线图的开发和验证

目的

微小乳头状甲状腺癌 (PTMC) 经常表现出良好的临床结果，而在某些人群中也可以发现侵袭性。确定 PTMC 患者大量 (> 5) 中央淋巴结转移 (CLNM) 的风险临床因素可以帮助肿瘤学家做出更好的个体化临床决策。

方法

我们回顾性分析了 2010 年 1 月至 2015 年 12 月期间监测、流行病学和最终结果 (SEER) 数据库以及 2018 年 1 月至 2020 年 10 月期间在重庆医科大学附属一家医疗中心的成人 PTC 患者的临床特征。单变量和多变量逻辑回归分析用于确定 PTMC 患者中大量 CLNM 的危险因素。

结果

男性（OR = 2.02, 95% CI 1.46–2.81），较大的肿瘤大小（> 5 mm，OR = 1.64, 95% CI 1.13–2.38），多灶性（OR = 1.87, 95% CI 1.40–2.51），和甲状腺外浸润（OR = 3.67；95% CI 2.64-5.10）是促进 PTMC 患者大量 CLNM 的独立危险因素。相比之下，诊断时的老年（≥ 55 岁）（OR = 0.57, 95% CI 0.40-0.81）和 PTMC 滤泡变量（OR = 0.60, 95% CI 0.42-0.87）被确定为保护因素。基于这些指标，进一步构建了一个具有良好一致性指数（C-index）为 0.702 的列线图，并得到了一个有希望的 C-index 为 0.811 的外部验证队列的支持。

结论

列线图已成功建立并通过六个临床指标进行验证。该模型可以帮助外科医生对 PTMC 患者的管理做出更好的个体化临床决策，特别是在是否需要进行预防性中央淋巴结清扫和术后放疗方面。