Objective: To explore the
risk factors affecting central
lymph node metastasis in cN0 isthmus
papillary thyroid carcinoma and the significance and feasibility of preventive
dissection , so as to provide reference for clinical
treatment .
Methods: The clinical data of 108
patients with cN0 stage isthmus
papillary thyroid cancer who underwent
surgery in the
General Surgery Department of Lianyungang Oriental
Hospital from January 2014 to December 2021 were retrospectively analyzed. There were 32
males and 76
females , with an age range of 24 to 70 years, with a mean age of (46.0±12.7) years.
Statistical analysis was performed using the SPSS 22.0 statistical
software .
Chi-square test and
logistic regression were used to analyze the relationship between central
lymph node metastasis and
patients Relationship between clinical case factors.Explore the feasibility of preventive cleaning.
Results: The positive rate of
lymph node metastasis in central region of isthmic
papillary thyroid carcinoma was 37.9% (41/108). Univariate
analysis showed that central
lymph node metastasis was associated with
tumor diameter ( χ2=5.36, P=0.021), capsular infiltration ( χ2=7.69, P=0.006), and elevated
thyroglobulin ( χ2=7.73, P=0.005).
Multivariate analysis showed that capsular infiltration ( HR=2.75, P=0.037) and
tumor diameter ( HR=4.454, P=0.004) were independent
risk factors for central
lymph node metastasis . The
ROC curve of
tumor diameter to predict central
lymph node metastasis was drawn, and the
AUC value of the area under the curve was calculated to be 0.720. When the diameter was 0.695 cm, the Youden index was 0.326, the
sensitivity was 0.878, and the
specificity was 0.448. 6 cases (5.56%) had temporary
recurrent laryngeal nerve palsy , 13 cases (12.04%) had temporary
hypoparathyroidism , no permanent
complications occurred.
Conclusions: cN0 stage PTCI has the
risk of early occult
lymph node metastasis . Prophylactic CLND can clarify the stage of the
tumor , assess the
risk , and guide the follow-up
treatment of
patients . CLND should be routinely performed for
patients with
tumor diameter >0.695 cm and capsular invasion.