Analysis of risk factors for level Ⅵ lymph node metastasis in cN0 papillary thyroid microcarcinoma
Zhang Haidong1,2, Gong Shanchun2, Liu Yaqun3, Yin Huaru4, Yin Honglin5, Yu Zhenkun1,2
1Graduate School of Medicine, Southeast University, Nanjing 210096, China; 2Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China; 3Department of Otorhinolaryngology and Head and Neck Surgery, Nanjing TongRen Hospital, Nanjing 211102, China; 4Department of Ultrasonography, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China; 5Department of Pathology, BenQ Medical Center, the Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
Abstract：Objective To explore the risk factors of level Ⅵ lymph node metastasis in cN0 papillary thyroid microcarcinoma (PTMC) and their clinical significance. Methods A cross-sectional study was conducted. A total of 154 patients with cN0 PTMC from the Department of Otolaryngology, Head and Neck Surgery, Nanjing TongRen Hospital and BenQ Medical Center Affiliated to Nanjing Medical University from March 2017 to December 2021 were enrolled. The patients included 48 males and 106 females, aged 21-70 years old, with a median age of 43 years. The tumor foci were in the left glandular lobe of 66 patients (62 with single cancer foci and 4 with multiple cancer foci), right glandular lobe of 65 patients (55 with single cancer foci and 10 with multiple cancer foci), and bilateral glandular lobe of 23 patients (20 with both single cancer foci and 3 with both multiple cancer foci). In summary, 137 patients had single foci while 17 patients had multiple foci. The patients with single foci were divided into the ventral and dorsal groups in accordance with the preoperative ultrasound, which was bounded by the 1/2 imaginary plane of the thyroid coronal plane. Among the patients, 34 suffered complications from Hashimoto's thyroiditis. All 154 patients received surgical treatment, and 177 sides of level Ⅵ lymph node dissection were performed. Postoperative complications. With pathological diagnosis as the "gold standard," the chi square test and multiple factor logistic regression analysis were conducted to statistically analyze level Ⅵ lymph node metastasis rate, influencing factors. Results Postoperative complications of temporary recurrent laryngeal nerve palsy and parathyroid damage were noted in 6.7% (12/177) and 16.8% (26/154) of the patients with a follow-up time of 4 months and 57 months, respectively. No recurrence and lymph node metastasis were observed. For the 154 patients who participated in the study, 177 sides of lymph nodes in region Ⅵ were dissected, and 61 sides (34.4%) were found to have lymph node metastasis. The metastasis rate was 16.4% (14/85) in the ventral group, 55.5% (40/72) in the dorsal group, and 35.0% (7/20) in the multifocal patients. Univariate analysis indicated no statistical significance in the lymph node metastasis rate of the cN0 PTMC Ⅵ region among patients with different gender, age (55 years old as the boundary point), Hashimoto's thyroiditis, and multiple foci (all P values>0.05). A significant difference was found in the lymph node metastasis rate of cN0 PTMC Ⅵ between patients in the ventral and dorsal groups (χ2=26.39, P<0.001). The multivariate logistic regression analysis indicated that tumor location was an independent risk factor for level Ⅵ lymph node metastasis in stage cN0 PTMC (odds ratio: 0.16; 95% confidence interval: 0.08-0.33; P<0.001); that is, the risk of lymph node metastasis in the ventral group is 0.16 times higher than that in the dorsal group. Conclusion Dorsal location was a risk factor for level Ⅵ lymph node metastasis in stage cN0 PTMC. Therefore, routine dissection of ipsilateral level Ⅵ lymph node is recommended for stage cN0 PTMC in the dorsal thyroid.
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2023, Vol. 28 
