Analysis of characteristics and influencing factors of cervical lymph node skip metastasis in papillary thyroid carcinoma / 国际外科学杂志

ABSTRACT

Objective:To analyze the characteristics and influencing factors of the patients with cervical lymph node skip metastasis of papillary thyroid carcinoma (PTC), as to guide the precise treatment of lateral area.Methods:The clinicopathological data of 237 patients with PTC initially diagnosed and treated in Xuanwu Hospital Capital Medical University from Feb 2014 to Mar 2022 were analyzed retrospectively. Among them, there were 217 positive in the central area, and 20 negative, with skip rate 8.4%. The age, sex, pathological type, glandular lobe involvement, tumor size, number of tumor lesions, primary lesion location, and capsule invasion were statistically compared. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. The measurement data of non normal distribution are expressed by M( Q1, Q3), and the Mann Whitney U test is used for comparison between groups. Comparison between groups of count data was conducted using the chi-square test, correction chi-square or Fisher exact probability. Results:Multivariate analysis showed that age ≥ 55 years old( OR 6.032, 95% CI 1.692-21.504, P=0.006), female( OR 23.459, 95% CI 2.181-252.341, P=0.009), tumor ≤5 mm( OR 79.453, 95% CI 7.570-833.891, P<0.001)and located in the upper lobe( OR 3.446, 95% CI 1.325-8.962, P=0.011) were independent risk factors for skip metastasis. The patients with skip metastasis had a smaller total number of cervical lymph node metastases( Z=-2.81, P=0.005), smaller total number of neck dissection lymph nodes( Z=-6.62, P<0.001) and less lymph nodes metastases in level Ⅳ( Z=-2.54, P=0.011) than patients with non-skip metastasis. Conclusions:Skip metastasis often occurred with age ≥55 years, female, tumor size less than 5mm and located in the upper lobe. For these patients, careful evaluation for the lateral area is required.