AUTHOR=Ma Yunhan , Li Yi , Zheng Luming , He Qingqing 

TITLE=Prospective application of a prediction model for lateral lymph node metastasis in papillary thyroid cancer patients with central lymph node metastasis

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 14 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1283409

DOI=10.3389/fendo.2023.1283409

ISSN=1664-2392

ABSTRACT=Objective: To develop and apply a prediction model to estimating the probability of lateral lymph node metastasis (LLNM) in cN0 unilateral papillary thyroid carcinoma (PTC) patients with central lymph node metastasis (CLNM).Setting: All study information was collected from a single tertiary hospital.Methods: Univariable and multivariable logistic regression analyses were used to explore independent predictors for LLNM in the derivation and internal validation cohort which were used to construct and validate a nomogram. Another 96 patients from were included prospectively to evaluate the efficacy of this nomogram.Results: Maximum tumor diameter greater than 1.0cm (OR, 2.712; 95% CI, 1.412-5.210), multifocality (OR, 2.758; 95% CI, 1.120-6.789), the number of CLNM≥3 (OR, 2.579; 95% CI, 1.315-5.789), the ratio of CLNM≥0.297 (OR, 2.905; 95% CI, 1.396-6.043) and tumor located in upper portion (OR 2.846, 95% CI 1.151-7.039) were independent predictors associated with LLNM. The prediction model showed excellent discrimination, with an AUC of 0.731 (95% CI, 0.635-0.827). A novel risk stratification of LLNM was constructed based on this nomogram. In the prospective cohort, we succeed to stratified these patients into three risk subgroups: low-, moderate-and high-risk subgroup and we found the probability of LLNM was positively correlated to the total points from the nomogram.This nomogram was applied in prospective clinical practice which distinguished PTC patients with a genuinely high risk of LLNM. Surgeons can use our nomogram to tailor surgical plan and determine further postoperative therapy credibly.