Cancer Res Treat.  2020 Oct;52(4):1010-1018. 10.4143/crt.2020.254.

Nomogram for Predicting Central Lymph Node Metastasis in Papillary Thyroid Cancer: A Retrospective Cohort Study of Two Clinical Centers

• Yang Z
• Heng Y
• Lin J
• Lu C
• Yu D
• Tao L
• Cai W

• KMID: 2507928
• DOI: http://doi.org/10.4143/crt.2020.254

Abstract

Purpose
Central lymph node metastasis (CNM) are highly prevalent but hard to detect preoperatively in papillary thyroid carcinoma (PTC) patients, while the significance of prophylactic compartment central lymph node dissection (CLND) remains controversial as a treatment option. We aim to establish a nomogram assessing risks of CNM in PTC patients, and explore whether prophylactic CLND should be recommended.
Materials and Methods
One thousand four hundred thirty-eight patients from two clinical centers that underwent thyroidectomy with CLND for PTC within the period 2016–2019 were retrospectively analyzed. Univariate and multivariate analysis were performed to examine risk factors associated with CNM. A nomogram for predicting CNM was established, thereafter internally and externally validated.
Results
Seven variables were found to be significantly associated with CNM and were used to construct the model. These were as follows: thyroid capsular invasion, multifocality, creatinine > 70 μmol/L, age < 40, tumor size > 1 cm, body mass index < 22, and carcinoembryonic antigen > 1 ng/mL. The nomogram had good discrimination with a concordance index of 0.854 (95% confidence interval [CI], 0.843 to 0.867), supported by an external validation point estimate of 0.825 (95% CI, 0.793 to 0.857). A decision curve analysis was made to evaluate nomogram and ultrasonography for predicting CNM.
Conclusion
A validated nomogram utilizing readily available preoperative variables was developed to predict the probability of central lymph node metastases in patients presenting with PTC. This nomogram may help surgeons make appropriate surgical decisions in the management of PTC, especially in terms of whether prophylactic CLND is warranted.

Keyword

Nomograms; Central lymph node metastasis; Papillary thyroid cancer; Risk factors

Figure

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  Fig. 1. Univariate (A) and multivariate (B) logistic regression of factors associated with central lymph node metastasis (CNM). BIL, bilirubin; CEA, carcinoembryonic antigen; Cr, creatinine; RBC, red blood cell; Mon, monocyte; Neu, neutrophil; WBC, white blood cell; MTD, maximum tumor diameter; TCI, thyroid capsular invasion; iNG, ipsilateral Nodular Goiter; iHT, ipsilateral Hashimoto thyroiditis; BMI, body mass index.

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  Fig. 2. The nomogram for predicting risk of possible central lymph node metastasis (CNM) in papillary thyroid carcinoma patients. TCI, thyroid capsular invasion; Cr, creatinine; BMI, body mass index; CEA, carcinoembryonic antigen.

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  Fig. 3. Evaluation and Validation of the nomogram. (A) The receiver operating characteristics (ROC) curve and area under the ROC curve (AUC) of the nomogram. (B) The calibration curve of the nomogram for predicting possible central lymph node metastasis. Actual probability is plotted on the y-axis, and nomogram predicted probability on the x-axis.

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  Fig. 4. The calibration curve of the nomogram for external validation set. ROC, receiver operating characteristics.

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  Fig. 5. (A) Nomogram without serum index for predicting central lymph node metastasis (CNM) in papillary thyroid carcinoma (PTC) patients. (B) The calibration curve of the nomogram excluding serum index. BMI, body mass index; TCI, thyroid capsular invasion; ROC, receiver operating characteristics.

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  Fig. 6. Decision curve analysis for comparing our nomogram and ultrasonography in predicting central lymph node metastasis in papillary thyroid carcinoma patients.

Reference

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