High-risk factors for lymph node metastasis in contralateral central compartment in unilateral papillary thyroid carcinoma（cT1N0）

High-risk factors for lymph node metastasis in contralateral central compartment in unilateral papillary thyroid carcinoma（cT1N0）:



Publication date: Available online 18 October 2020

Source: European Journal of Surgical Oncology

Author(s): Bin Zhou, Jianwu Qin



Abstract

Objective

The incidence of papillary thyroid carcinoma (PTC) increases yearly. Central lymph node metastasis (CLNM) is common in PTC. Many studies have addressed ipsilateral CLNM; however, few studies have evaluated contralateral CLNM. The purpose of this study is to investigate the high-risk factors of lymph node metastasis in the contralateral central compartment of cT1 stage in PTC.



Methods

In total, 369 unilateral PTC (cT1N0) patients who underwent total-thyroidectomy with bilateral central lymph node dissection (CLND) between 2013 and 2016 in our hospital were retrospectively enrolled. Univariate and multivariate analyses identified the high-risk factors for contralateral CLNM of PTC.



Results

The total metastasis rate of the ipsilateral central neck compartment was 31.71% (117/369). The total metastasis rate of the contralateral central neck compartment was 8.13% (30/369). The multivariate analysis showed that multifocality (p = 0.009), ipsilateral CLNM (p＜0.001), number of ipsilateral CLNM ＞2 (p = 0.006), tumor located at the inferior pole (p = 0.032) and tumor diameter ＞ 1 cm (p = 0.029) were independent risk factors for contralateral CLNM at cT1 stage in PTC, with odds ratios (ORs) of,4.132 (95% confidence intervals (CI): 1.430–11.936) ，8.591 (95% CI: 3.200–23.061) ，0.174 (95% CI: 0.050–0.601) ，0.353 (95% CI: 0.136–0.917)and 0.235 (95% CI: 0.064–0863), respectively.



Conclusion

The combinational use of these risk factors will help surgeons devise an appropriate surgical plan preoperatively. This information could provide reference for the readers who are interested and help to determine the optimal extent of CLND in patients with PTC, especially for cT1b patients.



Keywords

Papillary thyroid carcinomaRisk factorsCentral lymph node metastasisContralateral central compartmentClinically node negative

Abbreviations

PTCPapillary thyroid carcinomaDTCdifferentiated thyroid carcinomaETEextrathyroidal extensionLNMLymph node metastasisCLNMcentral lymph node metastasisPTMCPapillary thyroid microcarcinomaCLNDcentral lymph node dissectionCTcomputed tomographyUSultrasoundSDstandard deviationORodds ratioCIconfidence interval