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Prediction model of lymph node metastasis posterior to the right recurrent laryngeal nerve

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Abstract

Background

At present, it is still controversial whether lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) patients should be dissected. Failure to dissect metastatic lymph nodes results in continued metastasis from the positive lymph nodes to other regions. Our study aimed to establish a predictive model and predict the probability of metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve (LNM-prRLN) in patients.

Methods

A total of 309 patients underwent surgery for thyroid cancer between May 2019 and September 2022. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic (ROC) curve to verify the accuracy of the prediction model.

Results

Multivariate analysis showed that irregular tumor margins (OR: 3.549, 95% CI 1.294–9.733, P = 0.014), extrathyroidal extension (OR: 4.507, 95% CI 1.694–11.993, P = 0.003), maximum tumor diameter > 1 cm (OR: 5.729, 95% CI 2.617–12.542, P < 0.001), overweight status (OR: 2.296, 95% CI 1.057–4.987, P = 0.036), high total cholesterol level (OR: 5.238, 95% CI 2.304–11.909, P < 0.001), and multifocality (OR: 11.954, 95% CI 5.233–27.305, P < 0.001) were independent risk factors for LNM-prRLN. The area under the ROC curve was 0.927. The calibration curve showed good agreement between the predicted and observed rates of LNM-prRLN.

Conclusion

The probability of LNM-prRLN could be predicted by a nomogram based on the statistically significant risk factors identified in the multivariate analysis. This nomogram can guide clinicians when preoperatively evaluating the status of the LN-prRLN with regard to LNM-prRLN in PTC patients. For patients at high risk for LNM-prRLN, the preventive dissection of LN-prRLNs can be considered.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Authors and Affiliations

  1. Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China

    Gao-Feng Qi, Jia-Wei Feng, Wan-Xiao Wu, Jing Ye, Li-Zhao Hong, Sheng-Yong Liu & Yong Jiang

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  1. Gao-Feng Qi
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  2. Jia-Wei Feng
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Qi, GF., Feng, JW., Wu, WX. et al. Prediction model of lymph node metastasis posterior to the right recurrent laryngeal nerve. Eur Arch Otorhinolaryngol 280, 3429–3435 (2023). https://doi.org/10.1007/s00405-023-07946-6

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  • DOI: https://doi.org/10.1007/s00405-023-07946-6

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