The preoperative predictive value of a nomogram for predicting cervical lymph node metastasis in papillary thyroid microcarcinoma patients based on SEER database_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Li’na ¹ , LING Yuwei ¹ , LI Kaifu ¹ , ZHAO Ye ¹ , ZHAO Jing ¹ , YANG Jingchun ² , LENG Zhenpeng ² ,  KANG Hua ¹

1. Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053,P. R. China;
2. Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding?author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

papillary microcarcinoma; cervical lymph node metastasis; risk factor; nomogram; ultrasound imaging characteristic

DOI：

10.7507/1007-9424.202106008

Video：

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Objective To explore the potential indicators of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC) patients and to develop a nomogram model. Methods The clinicopathologic features of PTMC patients in the SEER database from 2004 to 2015 and PTMC patients who were admitted to the Center for Thyroid and Breast Surgery of Xuanwu Hospital from 2019 to 2020 were retrospectively analyzed. The records of SEER database were divided into training set and internal verification set according to 7∶3. The patients data of Xuanwu Hospital were used as the external verification set. Logistic regression and Lasso regression were used to analyze the potential indicators for cervical lymph node metastasis. A nomogram was developed and whose predictive value was verified in the internal and external validation sets. According to the preoperative ultrasound imaging characteristics, the risk scores for PTMC patients were further calculated. The consistency between the scores based on pathologic and ultrasound imaging characteristics was verified. Results The logistic regression analysis results illustrated that male, age<55 years old, tumor size, multifocality, and extrathyroidal extension were associated with cervical lymph node metastasis in PTMC patients (P<0.001). The C index of the nomogram was 0.722, and the calibration curve exhibited to be a fairly good consistency with the perfect prediction in any set. The ROC curve of risk score based on ultrasound characteristics for predicting lymph node metastasis in PTMC patients was 0.701 [95%CI was (0.637 4, 0.765 6)], which was consistent with the risk score based on pathological characteristics (Kappa value was 0.607, P<0.001). Conclusions The nomogram model for predicting the lymph node metastasis of PTMC patients shows a good predictive value, and the risk score based on the preoperative ultrasound imaging characteristics has good consistency with the risk score based on pathological characteristics.

Citation： ZHANG Li’na, LING Yuwei, LI Kaifu, ZHAO Ye, ZHAO Jing, YANG Jingchun, LENG Zhenpeng, KANG Hua. The preoperative predictive value of a nomogram for predicting cervical lymph node metastasis in papillary thyroid microcarcinoma patients based on SEER database. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(2): 188-195. doi: 10.7507/1007-9424.202106008 Copy

1.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
2.	Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid cancer. Nat Rev Endocrinol, 2020, 16(1): 17-29.
3.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
4.	Khokhar MT, Day KM, Sangal RB, et al. Preoperative high-resolution ultrasound for the assessment of malignant central compartment lymph nodes in papillary thyroid cancer. Thyroid, 2015, 25(12): 1351-1354.
5.	Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: Diagnosis of central and lateral compartment nodal metastases. Eur J Radiol, 2019, 112: 14-21.
6.	Feng JW, Ye J, Wu WX, et al. Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence. J Endocrinol Invest, 2020, 43(12): 1807-1817.
7.	Liu C, Liu Y, Zhang L, et al. Risk factors for high-volume lymph node metastases in cN0 papillary thyroid microcarcinoma. Gland Surg, 2019, 8(5): 550-556.
8.	Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
9.	Brassard M, Borget I, Edet-Sanson A, et al. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab, 2011, 96(5): 1352-1359.
10.	Kaliszewski K, Diakowska D, Rzeszutko M, et al. Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence. PLoS One, 2020, 15(12): e0244930. doi: 10.1371/journal.pone.0244930.
11.	Zhao J, Zhao Y, Ling Y, et al. Risk factors of central lymph node metastasis in papillary thyroid microcarcinoma and the value of sentinel lymph node biopsy. Front Surg, 2021, 8: 680493. doi: 10.3389/fsurg.2021.680493.
12.	Ling Y, Zhang L, Li K, et al. Carbon nanoparticle-guided intraoperative lymph node biopsy predicts the status of lymph nodes posterior to right recurrent laryngeal nerve in cN0 papillary thyroid carcinoma. Gland Surg, 2021, 10(5): 1554-1563.
13.	Enewold L, Parsons H, Zhao L, et al. Updated overview of the SEER-medicare data: Enhanced content and applications. J Natl Cancer Inst Monogr, 2020, 2020(55): 3-13.
14.	鄭克思, 曾勇, 陳聰, 等. 基于監測、流行病學和最終結果數據庫甲狀腺乳頭狀微癌頸部淋巴結轉移的危險因素. 中國醫學科學院學報, 2018, 40(6): 736-743.
15.	吳元清, 林杰, 羅佳寶, 等. 甲狀腺微小乳頭狀癌淋巴結轉移和腺外侵犯的危險因素分析. 中華普外科手術學雜志 (電子版), 2021, 15(3): 319-322.
16.	王晨, 張國梁, 張守亮. 甲狀腺微小乳頭狀癌頸部中央區淋巴結轉移相關因素分析. 中國現代普通外科進展, 2020, 23(10): 821-822.
17.	Lu S, Zhao R, Ni Y, et al. Development and validation of a nomogram for preoperative prediction of cervical lymph node involvement in thyroid microcarcinoma. Aging (Albany NY), 2020, 12(6): 4896-4906.
18.	Wang Y, Guan Q, Xiang J. Nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma: A retrospective cohort study of 8 668 patients. Int J Surg, 2018, 55: 98-102.
19.	房居高, 楊帆. 甲狀腺微小乳頭狀癌規范化診療的進展與爭議. 中國耳鼻咽喉顱底外科雜志, 2021, 27(1): 1-5.
20.	高明. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
21.	Takami H, Ito Y, Okamoto T, et al. Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg, 2011, 35(1): 111-121.
22.	Ling Y, Zhao J, Zhao Y, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery. J Int Med Res, 2020, 48(9): 300060520952646. doi: 10.1177/0300060520952646.
23.	Luo X, Wang J, Xu M, et al. Risk model and risk stratification to preoperatively predict central lymph node metastasis in papillary thyroid carcinoma. Gland Surg, 2020, 9(2): 300-310.
24.	Wang Y, Nie F, Wang G, et al. Value of combining clinical factors, conventional ultrasound, and contrast-enhanced ultrasound features in preoperative prediction of central lymph node metastases of different sized papillary thyroid carcinomas. Cancer Manag Res, 2021, 13: 3403-3415.
25.	Sun J, Jiang Q, Wang X, et al. Nomogram for preoperative estimation of cervical lymph node metastasis risk in papillary thyroid microcarcinoma. Front Endocrinol (Lausanne), 2021, 12: 613974. doi: 10.3389/fendo.2021.613974.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin, 2020, 70(1): 7-30.
2. Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid cancer. Nat Rev Endocrinol, 2020, 16(1): 17-29.
3. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
4. Khokhar MT, Day KM, Sangal RB, et al. Preoperative high-resolution ultrasound for the assessment of malignant central compartment lymph nodes in papillary thyroid cancer. Thyroid, 2015, 25(12): 1351-1354.
5. Zhao H, Li H. Meta-analysis of ultrasound for cervical lymph nodes in papillary thyroid cancer: Diagnosis of central and lateral compartment nodal metastases. Eur J Radiol, 2019, 112: 14-21.
6. Feng JW, Ye J, Wu WX, et al. Management of cN0 papillary thyroid microcarcinoma patients according to risk-scoring model for central lymph node metastasis and predictors of recurrence. J Endocrinol Invest, 2020, 43(12): 1807-1817.
7. Liu C, Liu Y, Zhang L, et al. Risk factors for high-volume lymph node metastases in cN0 papillary thyroid microcarcinoma. Gland Surg, 2019, 8(5): 550-556.
8. Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
9. Brassard M, Borget I, Edet-Sanson A, et al. Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients. J Clin Endocrinol Metab, 2011, 96(5): 1352-1359.
10. Kaliszewski K, Diakowska D, Rzeszutko M, et al. Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence. PLoS One, 2020, 15(12): e0244930. doi: 10.1371/journal.pone.0244930.
11. Zhao J, Zhao Y, Ling Y, et al. Risk factors of central lymph node metastasis in papillary thyroid microcarcinoma and the value of sentinel lymph node biopsy. Front Surg, 2021, 8: 680493. doi: 10.3389/fsurg.2021.680493.
12. Ling Y, Zhang L, Li K, et al. Carbon nanoparticle-guided intraoperative lymph node biopsy predicts the status of lymph nodes posterior to right recurrent laryngeal nerve in cN0 papillary thyroid carcinoma. Gland Surg, 2021, 10(5): 1554-1563.
13. Enewold L, Parsons H, Zhao L, et al. Updated overview of the SEER-medicare data: Enhanced content and applications. J Natl Cancer Inst Monogr, 2020, 2020(55): 3-13.
14. 鄭克思, 曾勇, 陳聰, 等. 基于監測、流行病學和最終結果數據庫甲狀腺乳頭狀微癌頸部淋巴結轉移的危險因素. 中國醫學科學院學報, 2018, 40(6): 736-743.
15. 吳元清, 林杰, 羅佳寶, 等. 甲狀腺微小乳頭狀癌淋巴結轉移和腺外侵犯的危險因素分析. 中華普外科手術學雜志 (電子版), 2021, 15(3): 319-322.
16. 王晨, 張國梁, 張守亮. 甲狀腺微小乳頭狀癌頸部中央區淋巴結轉移相關因素分析. 中國現代普通外科進展, 2020, 23(10): 821-822.
17. Lu S, Zhao R, Ni Y, et al. Development and validation of a nomogram for preoperative prediction of cervical lymph node involvement in thyroid microcarcinoma. Aging (Albany NY), 2020, 12(6): 4896-4906.
18. Wang Y, Guan Q, Xiang J. Nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma: A retrospective cohort study of 8 668 patients. Int J Surg, 2018, 55: 98-102.
19. 房居高, 楊帆. 甲狀腺微小乳頭狀癌規范化診療的進展與爭議. 中國耳鼻咽喉顱底外科雜志, 2021, 27(1): 1-5.
20. 高明. 甲狀腺結節和分化型甲狀腺癌診治指南. 中國腫瘤臨床, 2012, 39(17): 1249-1272.
21. Takami H, Ito Y, Okamoto T, et al. Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg, 2011, 35(1): 111-121.
22. Ling Y, Zhao J, Zhao Y, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery. J Int Med Res, 2020, 48(9): 300060520952646. doi: 10.1177/0300060520952646.
23. Luo X, Wang J, Xu M, et al. Risk model and risk stratification to preoperatively predict central lymph node metastasis in papillary thyroid carcinoma. Gland Surg, 2020, 9(2): 300-310.
24. Wang Y, Nie F, Wang G, et al. Value of combining clinical factors, conventional ultrasound, and contrast-enhanced ultrasound features in preoperative prediction of central lymph node metastases of different sized papillary thyroid carcinomas. Cancer Manag Res, 2021, 13: 3403-3415.
25. Sun J, Jiang Q, Wang X, et al. Nomogram for preoperative estimation of cervical lymph node metastasis risk in papillary thyroid microcarcinoma. Front Endocrinol (Lausanne), 2021, 12: 613974. doi: 10.3389/fendo.2021.613974.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The preoperative predictive value of a nomogram for predicting cervical lymph node metastasis in papillary thyroid microcarcinoma patients based on SEER database

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