Nomogram for Predicting Lateral Lymph Node Metastasis in Medullary Thyroid Carcinoma: A Retrospective Cohort Study of Single Clinical Center

Abstract

Background Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor originating from parafollicular C cells of the thyroid, accounting for only 5% of all thyroid carcinomas. Lateral lymph nodes metastasis (LLNM) are the most important indicator of distant metastasis and clinical outcomes. Surgery is the only curative treatment for MTC, which is recommended to remove all lesions in the neck. We aim to establish a nomogram assessing risk factors of LLNM in MTC patients, and help surgeons make preoperative therapeutic decisions. Materials and Methods Totally 63 patients of a single clinical center between January 2013 and December 2020 were studied. Univariate and multivariate analysis were performed to examine risk factors associated with central lymph node metastasis (CNM) and LLNM. A nomogram for predicting LLNM was established. Results Several preoperative clinical features were found to be significantly associated with LLNM and were used to construct the model, including diameter > 1.6cm, calcitonin (CT) > 658.87 pg/mL, carcinoembryonic antigen (CEA) > 60 ng/ml. The nomogram had good discrimination with a concordance index of 0.961 (95% confidence interval [CI], 0.916 to 1). A decision curve analysis was made to evaluate the nomogram. Conclusions A nomogram was made to predict the probability of LLNM in patients presenting with MTC, which would help surgeons make appropriate therapeutic decisions.