Clin Endocrinol (Oxf). 2022 Oct 20. doi: 10.1111/cen.14834. Online ahead of print.
ABSTRACT
BACKGROUND: Papillary thyroid microcarcinoma (PTMC) comprises more than 50% of all newly detected cases of papillary thyroid carcinoma (PTC). High volume lymph node metastasis (involving >5 lymph nodes) (hv-LNM) is associated with PTMC recurrence. In half of the clinically node-negative (cN0) PTMC patients, central lymph node metastasis (CLNM) is pathologically present. However, clinical risk factors for high volume CLNM (hv-CLNM) in cN0 PTMC have not been defined well. Therefore, we aimed to obtain evidence for hv-CLNM risk factors in cN0 PTMC.
METHODS: Data on patients who visited our hospital between January 2020 and December 2021 were collected; preoperative diagnosis of cN0 and a postoperative pathological confirmation of PTMC were obtained. After filtering by inclusion versus exclusion criteria, the obtained data (N=2268) were included in the meta-analysis. Relevant studies published as of April 10, 2022 were identified from Web of Science, PubMed, WANFANG, and CNKI databases. These eligible studies were included in the meta-analysis and the association between clinicopathological factors and hv-CLNM in cN0 PTMC was assessed. SPSS and MetaXL were used for statistical analyses.
RESULTS: The meta-analysis included 10 previous studies (11734 patients) and 2268 patients enrolled in our hospital for a total of 14002 subjects. The results of which suggested that younger age (<40, OR = 3.28, 95% CI = 2.75-3.92, p<0. 001 or <45 OR = 2.93, 95%CI = 2.31-3.72, p<0. 001), male sex (OR = 2.81, 95% CI = 2.25-3.52, p<0.001), tumor size>5mm (OR = 1.85, 95%CI = 1.39-2.47, p<0.001), multifocality (OR = 1.88, 95%CI = 1.56-2.26, p<0.001), extrathyroidal extension (OR = 2.58, 95%CI = 2.02-3.30, p<0. 001), capsule invasion (OR = 2.02, 95%CI = 1.46-2.78, p<0.001), microcalcification (OR = 3.25, 95%CI = 2.42-4.36, p<0.001), and rich blood flow (OR = 1.65, 95%CI = 1.21-2.25, p = 0.002) were the significant factors related to an elevated hv-CLNM risk in cN0 PTMC patients. Hashimoto thyroiditis (OR = 0.76, 95%CI = 0.55-1.07, p = 0.114), irregular margin (VS regular margin, OR = 0.96, 95%CI = 0.68-1.33, p = 0.787), and hypoechoic (VS Non-hypoechoic, OR = 1.27, 95%CI = 0.84-1.92, p = 0.261) showed no significant association with hv-CLNM.
CONCLUSION: Younger age, tumor size>5mm, males, extrathyroidal extension, multifocality, microcalcification, capsular invasion, and rich blood flow were the significant clinicopathological risk factors for hv-CLNM risk in cN0 PTMC patients. These predictors may compensate for the sensitivity of imaging diagnosis in the preoperative period, thus helping in the effective identification of PTMCs with an invasive phenotype. This article is protected by copyright. All rights reserved.
PMID:36263602 | DOI:10.1111/cen.14834
