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Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma

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Abstract

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.

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Availability of data and material

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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Acknowledgements

We acknowledged Dr. Shenghao Fan for the substantial contribution to thyroid surgery in our department. We also thank the designers of “Hiplot” software for drawing figures. Also, we acknowledge the contributions of the Surveillance, Epidemiology, and End Results (SEER) Program registries for creating and updating the SEER database.

Funding

This work was supported by the National Natural Science Foundation of China (NSFC No. 81972460) for Guobing Yin.

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Author notes

  1. X. Wei and Y. Min have contributed equally to this work and share the first authorship.

Authors and Affiliations

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

    X. Wei

  2. 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. Min, Y. Feng, D. He, S. Fan, H. Chen, J. Chen, K. Xiang, H. Luo, G. Yin & D. Hu

  3. Department of Oncology, The Second Affiliated Hospital, Chongqing Medical University, No. 74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People’s Republic of China

    X. Zeng

  4. Department of Pathology, The Second Affiliated Hospital of Chongqing Medical University, No. 74, Linjiang Rd, Yuzhong Dist, Chongqing, 404100, People’s Republic of China

    Y. Huang

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Contributions

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

Corresponding authors

Correspondence to G. Yin or D. Hu.

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The authors declare that they have no conflict of interest.

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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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Wei, X., Min, Y., Feng, Y. et al. Development and validation of an individualized nomogram for predicting the high-volume (> 5) central lymph node metastasis in papillary thyroid microcarcinoma. J Endocrinol Invest 45, 507–515 (2022). https://doi.org/10.1007/s40618-021-01675-5

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