The risk of central nodal metastasis based on prognostic factors of the differentiated thyroid carcinoma: a systematic review and meta-analysis study

Abstract

Background and aim Despite improving the 10-year disease-free-survival, prophylactic central neck dissection (pCND) in differentiated thyroid carcinoma (DTC) should only be considered in patients with high risk factors for lymph node (LN) metastasis due to the increases in the risk of postoperative complications. Our aim was to identify the risk factors for central lymph node metastasis (CLNM) in DTC. Method We searched PubMed, Scopus, Web of science, Cochrane library for eligible studies from inception to November 1, 2021 and a systematic review and meta-analysis were carried out to identify the risk factors for CLNM in DTC. Results We included 41 studies with total of 27,741 patients in this study. The pooled results in this meta-analysis showed that these risk factors were significantly associated with CLNM: age < 45 years (odds ratio (OR) 1.64, 95% confidence interval (CI) 1.34–1.99, p < 0.00001), male sex (OR 1.73, 95% CI 1.54–1.93, p < 0.00001), multifocality (OR 1.87, 95% CI 1.59–2.19, p < 0.00001), bilateral disease (OR 1.43, 95% CI 1.15–1.78, p < 0.001), capsular invasion (OR 1.67, 95% CI 1.10–2.54, p < 0.02), lymphovascular invasion (OR 4.89, 95% CI 2.76–8.66, p < 0.00001) and extra-thyroidal extension (OR 2.43, 95% CI 1.97–3.00, p < 0.00001). In addition, young age (< 45 years), male sex, multifocality, and extra-thyroidal extension were significantly associated with large-volume CLNM in clinically N0 DTC patients. However, the presence of Hashimoto’s thyroiditis was not a predictors of large-volume CLNM. Conclusion Young age (< 45 years), male sex, bilateral disease, multifocality, capsular invasion, lymphovascular invasion and extra-thyroidal extension are significantly associated with CLNM and pCND would be expected to have a higher yield in patients with these risk factors.

Landscape of gene mutation in Chinese thyroid cancer patients: Construction and validation of lymph node metastasis prediction model based on clinical features and gene mutation marker

“…34 A systematic review and meta-analysis encompassing 27,741 patients from 41 studies indicated that age < 45 years and male gender were risk factors for central lymph node metastasis. 35 A 2010 study based on a Korean population found that tumor diameter >2 cm was significantly associated with lymph node metastasis, 36 while a 2012 Japanese study supported this finding, stating that tumor size (>2 cm) was the strongest predictor of microscopic central and lateral node metastasis in multivariate logistic analysis. Moreover, tumor size most markedly impacted DCA, and clinical impact curve, all the results indicated that the nomogram presenting a high accuracy.…”

“…A study from central China discovered that patients aged ≤18 years (OR = 4.41, p < 0.001) and 19–45 years (OR = 1.97, p = 0.002) had a higher risk of lateral LNM than patients aged >60 years 34 . A systematic review and meta‐analysis encompassing 27,741 patients from 41 studies indicated that age < 45 years and male gender were risk factors for central lymph node metastasis 35 . A 2010 study based on a Korean population found that tumor diameter >2 cm was significantly associated with lymph node metastasis, 36 while a 2012 Japanese study supported this finding, stating that tumor size (>2 cm) was the strongest predictor of microscopic central and lateral node metastasis in multivariate logistic analysis.…”

The model for predicting the central lymph node metastasis in cN0 papillary thyroid microcarcinoma with Hashimoto’s thyroiditis

“…The 2015 American Thyroid Association (ATA) guidelines recommend therapeutic central lymph node dissection (CLND) in patients with lymph node metastasis (LNM) ( 6 ), while prophylactic central lymph node remains controversial for patients with cN0. Several studies have reported significant improvements in 10-year disease survival and local area control in PTC with bilateral pCND followed by personalized radioiodine therapy ( 7 ). Furthermore, studies have indicated that performing pCND in stage clinical lymph node-negative (cN0) patients does not significantly reduce the risk of local recurrence.…”