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Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma

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Abstract

Purpose

Patients with papillary thyroid carcinoma (PTC) frequently present a relatively poor prognosis when they coexist with cervical lymph node metastasis (LNM). Moreover, it remains controversial whether prophylactic lymph node dissection (LND) should be performed for patients without clinically lymph node metastasis. Thus, we hereby develop a nomogram for predicting the cervical LNM (including central and lateral LNM) in patients with PTC.

Methods

We retrospectively reviewed the clinical characteristics of adult patients with PTC in the surveillance, epidemiology, and end results (SEER) database between 2010 and 2015 and in our Department of Breast and Thyroid Surgery in the Second Affiliated Hospital of Chongqing Medical University between 2019 and 2020.

Result

A total of 21,972 patients in the SEER database and 747 patients in our department who met the inclusion criteria were enrolled in this study. Ultimately, six clinical features including age, gender, race, extrathyroidal invasion, multifocality, and tumor size were identified to be associated with cervical LNM in patients with PTC, which were screened to develop a nomogram. This model had satisfied discrimination with a concordance index (C-index) of 0.733, supported by both internal and external validation with a C-index of 0.731 and 0.716, respectively. A decision curve analysis was subsequently made to evaluate the feasibility of this nomogram for predicting cervical LNM. Besides, a positive correlation between nomogram score and the average number of lymph node metastases was observed in all groups.

Conclusion

This visualized multipopulational-based nomogram model was successfully established. We determined that various clinical characteristics were significantly associated with cervical LNM, which would be better helping clinicians make individualized clinical decisions for PTC patients.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The software application generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Y. Feng and Y. Min authors are contributed equally to this work.

Authors and Affiliations

  1. Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People’s Republic of China

    Y. Feng, Y. Min, H. Chen, K. Xiang, X. Wang & G. Yin

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  1. Y. Feng
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  2. Y. Min
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  3. H. Chen
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  4. K. Xiang
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  5. X. Wang
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  6. G. Yin
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Contributions

(I) Conception and design: YM, YF; (II) Administrative support: XW, GY; (III) Provision of study materials or patients: YF, HC, YM; (IV) Collection and assembly of data: YM, KX; (V) Data analysis and interpretation: YM, YF; (VI) Manuscript writing: All authors.; (VII) Final approval of manuscript: All authors.

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Correspondence to G. Yin.

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Ethical approval was waived by the local Ethics Committee of the Chongqing Medical University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Feng, Y., Min, Y., Chen, H. et al. Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest 44, 2203–2211 (2021). https://doi.org/10.1007/s40618-021-01524-5

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  • DOI: https://doi.org/10.1007/s40618-021-01524-5

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