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Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

Authors Luo Y, Xu XC, Shen J, Shi JJ, Lu S, He W, Lei JY, Luo DC

Received 13 March 2018

Accepted for publication 3 May 2018

Published 6 August 2018 Volume 2018:10 Pages 2449—2455


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Leylah Drusbosky

Yi Luo,1 Xiao-Cheng Xu,2 Jie Shen,3 Jing-Jing Shi,4 Si Lu,5 Wei He,6 Jian-Yong Lei,7 Ding-Cun Luo4

1West China School of Medicine, Sichuan University, Chengdu, China; 2Department of Surgery of Thyroid and Breast, Wujiang District of Suzhou First People’s Hospital, Suzhou, China; 3Clinical Medical College, Nanjing Medical University, Nanjing, China; 4Department of Surgical Oncology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou, China; 5Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China; 6Department of Oncology, Taixing People’s Hospital, Taixing, China; 7Department of Thyroid Surgery, West China hospital of Sichuan University, Chengdu, China

Background: Cervical lymph node metastasis (LNM) is a prognostic factor of papillary thyroid carcinoma (PTC). The way to deal with lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is controversial. Nevertheless, if metastatic lymph nodes are not removed during the first operation, the subsequent salvage surgery of recurrent tumor in this area would entail high risk and complication. The purpose of this study was to develop a preoperative prediction model for LN-prRLN metastasis in PTC patients using clinicopathological characteristics.
Patients and methods: We performed a prospective study of 595 patients with PTC who underwent LN-prRLN dissection from March 2014 to June 2017. The clinicopathological data were randomly divided into derivation (n=476) and validation sets (n=119). A predictive model was initially established based upon the data of the derivation set via multivariate analyses, and the accuracy of the model was then examined with data of the validation set. The discriminative power of this model was assessed in both sets.
Results: Metastases of the LN-prRLN were identified in 102 (17.14%) of 595 patients. Age (odds ratio [OR] 0.971, 95% CI, 0.949–0.994, p=0.013), tumor size (OR 2.163, 95% CI, 1.431–3.270, p<0.001), capsular invasion (OR 1.934, 95% CI, 1.062–3.522, p=0.031), and right LNM (OR 3.786, 95% CI, 2.012–7.123, p<0.001) were significantly associated with LN-prRLN metastasis. The areas under the curves were 0.790 for the derivation set (sensitivity 71.95%, specificity 78.68%) and 0.878 for the validation set (sensitivity 85.00%, specificity 78.79%).
Conclusion: We developed and validated the first model to predict LN-prRLN metastases in patients with PTC based on clinicopathological parameters.

Keywords: papillary thyroid carcinoma, lymph node posterior to right recurrent laryngeal nerve, neck dissection, risk factors, metastasis, model

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