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BRAFV600E 多变量模型与预测 cN0 甲状腺微小乳头状癌中央淋巴结转移风险的超声特征
Authors Chen BD, Zhang Z, Wang KK, Shang MY, Zhao SS, Ding WB, Du R, Yu Z, Xu XM
Received 30 December 2018
Accepted for publication 4 July 2019
Published 30 July 2019 Volume 2019:11 Pages 7211—7217
DOI https://doi.org/10.2147/CMAR.S199921
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Beicheng Sun
Background: Prophylactic central lymph node dissection (CLND) in papillary thyroid microcarcinoma (PTMC) patients without clinical evidence of central lymph node metastasis (CLNM) remains controversial. The purpose of our study is to identify preoperative predictive factors for finding CLNM in Chinese PTMC patients, which may allow tailored CLND.
Methods: We retrospectively reviewed 182 consecutive Chinese PMTC patients with negative central lymph nodes who underwent total thyroidectomy plus central neck dissection from October 2015 to December 2017. Chi-squared and multivariate analysis were performed to evaluate the association of CLNM with ultrasonographic and clinicopathologic characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of markers in predicting CLNM.
Results: The CLNM was found in 39.0% (71 of 182) of cN0 PTMC patients. In multivariate analysis, tumor size>7 mm (OR: 3.636, 95% CI: 1.671–7.914), marked hypoechogenicity (OR: 2.686, 95% CI: 1.080–6.678), multifocality (OR: 4.184, 95% CI: 1.707–10.258) and BRAFV600E mutation (OR: 5.339, 95% CI: 2.529–11.272) were independent predictors of CLNM. In ROC analysis integrating these predictors, the sensitivity was 63.4% and specificity was 80.2%, and the area under the ROC (AUC) was 0.755.
Conclusion: In conclusion, we found tumor size>7 mm, marked hypoechogenicity, multifocality, and BRAFV600E mutation were risk factors for CLNM. In term of these preoperative risk factors for CLNM, prophylactic CLND should be cautiously performed in cN0 PTMC patients.
Keywords: central lymph node metastasis, prophylactic central lymph node dissection, papillary thyroid microcarcinoma, risk factor