Nomogram for predicting skip metastasis in cN0 papillary thyroid cancer patients at increased risk of lymph node metastasis

Abstract

Background. Skip lymph node metastasis (SLNM) refers to lateral lymph node metastasis (LLNM) without involving central lymph node (CLN). Some microscopic nodal positivity may be difficult to detect before surgery due to atypical imaging characteristics. These patients are misdiagnosed as having clinically nodenegative (cN0) papillary thyroid cancer (PTC) even after central lymph node dissection, leading to a high risk of developing LNM after surgery. Current prediction models have limited clinical utility, as they are only applicable to predict SLNM from clinically node-positive (cN+) PTC, not cN0 PTC, and this has little impact on treatment strategies.Objectives. This study aimed to establish a nomogram for preoperatively assessing the likelihood of SLNM in cN0 PTC patients with increased risk of LNM, thus optimizing their therapeutic options. Materials and methods.The records of 780 PTC patients undergoing thyroidectomy along with bilateral central lymph node dissection were retrospectively reviewed. The cN0 patients with postoperative LLNM (occult SLNM) and cN+ patients without central lymph node metastasis (CLNM) (typical SLNM) were included in the SLNM group (n = 82). The CLNM-negative cN0 patients without postoperative LLNM were assigned to the non-SLNM group (n = 698). The independent correlates of SLNM constituted the nomogram for determining the likelihood of SLNM in high-risk cN0 PTC patients.Results. The independent correlates of SLNM were age (hazard ratio (HR) = 1.016), tumor location (HR = 1.801), tumor size (HR = 1.528), and capsular invasion (HR = 2.941). They served as components in the development of the nomogram. This model was verified to present acceptable discrimination. It showed good calibration and a decent net benefit when the predicted probability was <60%.Conclusions. We developed a nomogram incorporating preoperative clinical data to predict the probability of SLNM development in high-risk cN0 PTC patients, which contributed to their optimized treatment options.

Risk factors and nomogram to predict skip metastasis in papillary thyroid carcinoma

“…The tumor invades the adjacent neck lymph nodes through blood vessels and lymphatic vessels, and even distant metastasis occurs ( 25 ). According to the previous studies ( 17 , 26 ), capsule invasion was also considered as a predictive factor of skip metastasis in PTC patients. In addition, the upper pole of thyroid tissue is relatively thin due to the butterfly shape of the thyroid gland.…”

Toll-like receptors in breast cancer immunity and immunotherapy

“…Understanding how these pathways regulate these processes in the context of TLR3 activation could provide insights into the complex roles TLR3 plays in breast cancer progression and tumor microenvironment modulation. Tumor cells exhibiting high TLR3 expression correlate with a higher likelihood of metastasis ( 30 ). Studies have reported elevated TLR3 expression in breast cancer cells compared to normal cells, with TLR3 activation linked to increased cell proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) in vitro , as well as enhanced tumor growth and metastasis in mouse xenograft models ( 60 ).…”

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

“…Papillary thyroid carcinoma that is located in the isthmus exhibits aggressiveness and is related to poor prognosis. A nomogram including incriminated factors for metastatic lymph nodes and worse outcome (gender, age, size of malignant lesion, thyroid cap invasion, and Hashimoto’s thyroiditis)[ 75 ], as for any other location of high-risk patients[ 76 ], predicts recurrence[ 77 ].…”