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Clinical prediction models for cervical lymph node metastasis of papillary thyroid carcinoma

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Abstract

Purpose

Accurate preoperative diagnosis of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains an unsolved problem. This study aimed to construct a nomogram and scoring system for predicting LNM based on the clinical characteristics of patients with PTC.

Methods

1400 patients with PTC who underwent thyroidectomy and lymph node dissection at the First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled and randomly divided into training and internal testing sets. Furthermore, 692 patients with PTC from three other medical centers were collected as external testing sets. Least absolute shrinkage and selection operator (LASSO) was used to screen the predictors, and a nomogram was constructed. In addition, a scoring system was constructed using 10-fold cross-validation. The performances of the two models were verified among datasets and compared with preoperative ultrasound (US).

Results

Six independent predictors were included in the multivariate logistic model: age, sex, US diagnosis of LNM, tumor diameter, location, and thyroid peroxidase antibody level. The areas under the receiver operating characteristic curve (AUROC) (95% confidence interval) of this nomogram in the training, internal testing, and three external testing sets were 0.816 (0.791–0.840), 0.782 (0.727–0.837), 0.759 (0.699–0.819), 0.749 (0.667–0.831), and 0.777 (0.726–0.828), respectively. The AUROC of the scoring system were 0.810 (0.785–0.835), 0.772 (0.718–0.826), 0.736 (0.675–0.798), 0.717 (0.635–0.799) and 0.756 (0.704–0.808), respectively. The prediction performances were both significantly superior to those of preoperative US (P < 0.001).

Conclusion

The nomogram and scoring system performed well in different datasets and significantly improved the preoperative prediction of LNM than US alone.

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References

  1. M. Pizzato, M. Li, J. Vignat et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 10(4), 264–272 (2022)

    Article  PubMed  Google Scholar 

  2. M. Brassard, I. Borget, A. Edet-Sanson et al. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J. Clin. Endocrinol. Metab. 96(5), 1352–1359 (2011)

    Article  CAS  PubMed  Google Scholar 

  3. J.A. Pereira, J. Jimeno, J. Miquel et al. Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138(6), 1095–1100 (2005)

    Article  PubMed  Google Scholar 

  4. C. Gambardella, E. Tartaglia, A. Nunziata et al. Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients. World J. Surg. Oncol. 14(1), 247 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  5. H.S. Hwang, L.A. Orloff, Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121(3), 487–491 (2011)

    Article  PubMed  Google Scholar 

  6. D.W. Lee, Y.B. Ji, E.S. Sung et al. Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma. Eur. J. Surg. Oncol. 39(2), 191–196 (2013)

    Article  CAS  PubMed  Google Scholar 

  7. K.J. Lee, Y.J. Cho, S.J. Kim et al. Analysis of the clinicopathologic features of papillary thyroid microcarcinoma based on 7-mm tumor size. World J. Surg. 35(2), 318–323 (2011)

    Article  PubMed  Google Scholar 

  8. C. Liu, C. Xiao, J. Chen et al. Risk factor analysis for predicting cervical lymph node metastasis in papillary thyroid carcinoma: a study of 966 patients. BMC Cancer 19(1), 622 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  9. B.R. Haugen, E.K. Alexander, K.C. Bible et al. 2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2016)

    Article  PubMed  PubMed Central  Google Scholar 

  10. S. Lai, Y. Fan, Y. Zhu et al. Machine learning-based dynamic prediction of lateral lymph node metastasis in patients with papillary thyroid cancer. Front. Endocrinol. (Lausanne) 13, 1019037 (2022)

    Article  PubMed  Google Scholar 

  11. Q. Hu, W.J. Zhang, L. Liang et al. Establishing a predictive nomogram for cervical lymph node metastasis in patients with papillary thyroid carcinoma. Front. Oncol. 11, 766650 (2021)

    Article  PubMed  Google Scholar 

  12. J. Mao, Q. Zhang, H. Zhang et al. Risk factors for lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Front. Endocrinol. (Lausanne) 11, 265 (2020)

    Article  PubMed  Google Scholar 

  13. E. Xia, Y. Chi, L. Jin et al. Preoperative prediction of lymph node metastasis in patients with papillary thyroid carcinoma by an artificial intelligence algorithm. Am. J. Transl. Res. 13(7), 7695–7704 (2021)

    PubMed  PubMed Central  Google Scholar 

  14. R. Rahbari, L. Zhang, E. Kebebew, Thyroid cancer gender disparity. Future Oncol. 6(11), 1771–1779 (2010)

    Article  CAS  PubMed  Google Scholar 

  15. M. Peng, G. Wei, Y. Zhang et al. Single-cell transcriptomic landscape reveals the differences in cell differentiation and immune microenvironment of papillary thyroid carcinoma between genders. Cell Biosci. 11(1), 39 (2021)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. X. Li, H. Zhang, Y. Zhou et al. Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study. World J. Surg. Oncol. 19(1), 138 (2021)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. J. Yu, Y. Deng, T. Liu et al. Lymph node metastasis prediction of papillary thyroid carcinoma based on transfer learning radiomics. Nat. Commun. 11(1), 4807 (2020)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. J. Zhan, H. Ding, Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 37(4), 288–297 (2018)

    Article  PubMed  PubMed Central  Google Scholar 

  19. W. Wang, X. Su, K. He et al. Comparison of the clinicopathologic features and prognosis of bilateral versus unilateral multifocal papillary thyroid cancer: an updated study with more than 2000 consecutive patients. Cancer 122(2), 198–206 (2016)

    Article  CAS  PubMed  Google Scholar 

  20. A.A. Afif, B.A. Williams, M.H. Rigby et al. Multifocal papillary thyroid cancer increases the risk of central lymph node metastasis. Thyroid 25(9), 1008–1012 (2015)

    Article  PubMed  Google Scholar 

  21. H.J. Kim, S.Y. Sohn, H.W. Jang et al. Multifocality, but not bilaterality, is a predictor of disease recurrence/persistence of papillary thyroid carcinoma. World J. Surg. 37(2), 376–384 (2013)

    Article  PubMed  Google Scholar 

  22. K.C. Loh, F.S. Greenspan, F. Dong et al. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J. Clin. Endocrinol. Metab. 84(2), 458–463 (1999)

    Article  CAS  PubMed  Google Scholar 

  23. X. Li, H.W. Zhang, Y. Zhou et al. Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study. World J. Surg. Oncol. 19(1), 138 (2021)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Y. Wang, J. Zheng, X. Hu et al. A retrospective study of papillary thyroid carcinoma: Hashimoto’s thyroiditis as a protective biomarker for lymph node metastasis. Eur. J. Surg. Oncol. 49(3), 560–567 (2023)

    Article  PubMed  Google Scholar 

  25. W. Wang, L. Wen, S. Chen et al. Preoperative thyroid peroxidase antibody predicts recurrence in papillary thyroid carcinoma: a consecutive study with 5,770 cases. Front. Oncol. 12, 881024 (2022)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Chinese Society of Endocrinology, Thyroid and Metabolism Surgery Group of the Chinese Society of Surgery, Chinese Society of Nuclear Medicine, et al. Guidelines for the diagnosis and management of thyroid nodules and differentiated thyroid cancer (Second edition). Chin J Endocrinol Metab, 2023, 39(3): 181-226. (In Chinese)

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Author contributions

X.C., Z.Y. and J.L. supervised the study. X.C., Y.L. and B.L. designed the study. S.L., F.L. and R.L. helped to organize the study. Y.H., W.C., J.Z., X.L., T.X. and Y.H. collected the data. R.L., B.L. and J.L. did the data analysis. S.L., F.L., R.L., B.L. and Y.L. wrote the draft report. X.C. performed critical revision on the manuscript. All authors contributed to the analysis and interpretation of data. All authors approved the final version before submission. The manuscript has been read and approved by all the authors. The requirements for authorship as stated in ICMJE Recommendations have been met. Each author believes that the manuscript represents honest work.

Funding

Funding

This study was funded by National Natural Science Foundation of China (82372047, 82271776 and 82103035), Guangzhou Science and Technology Project (2022342), and Research Fund of Medical Science and Technology of Guangdong Province (A2023093).

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Author notes

  1. These authors contributed equally: Shuli Luo, Fenghua Lai, Ruiming Liang, Bin Li.

Authors and Affiliations

  1. Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Shuli Luo, Fenghua Lai, Wenke Chen, Jiayuan Zhang, Xuyang Li, Tianyi Xu, Yingtong Hou, Yihao Liu & Xinwen Chen

  2. Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Ruiming Liang, Bin Li, Yihao Liu & Jianyan Long

  3. Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Yufei He

  4. Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China

    Zheng Yang

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  1. Shuli Luo
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Corresponding authors

Correspondence to Jianyan Long, Zheng Yang or Xinwen Chen.

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This study was approved by the Research Ethics Committee of the FAHSYSU. The requirement for informed consent was waived due to the retrospective nature of the study.

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Luo, S., Lai, F., Liang, R. et al. Clinical prediction models for cervical lymph node metastasis of papillary thyroid carcinoma. Endocrine 84, 646–655 (2024). https://doi.org/10.1007/s12020-023-03632-z

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