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. 2023 Jan 19:14:1112506.
doi: 10.3389/fendo.2023.1112506. eCollection 2023.

Nomogram for predicting central lymph node metastasis in T1-T2 papillary thyroid cancer with no lateral lymph node metastasis

Yubo Sun  1 , Wei Sun  1 , Jingzhe Xiang  1 , Hao Zhang  1
Affiliations

Nomogram for predicting central lymph node metastasis in T1-T2 papillary thyroid cancer with no lateral lymph node metastasis

Yubo Sun et al. Front Endocrinol (Lausanne). .

Abstract

Objective: Whether routine central lymph node dissection (CLND) is necessary for T1-T2 papillary thyroid carcinoma (PTC) patients without certain lateral lymph node metastases (LLNM) remains controversial. This study aims to construct a nomogram that predicts central lymph node metastasis (CLNM) for T1-T2 PTC patients without LLNM.

Methods: We retrospectively reviewed adult T1-T2 PTC patients with no LLNM retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. We also collected data from patients treated at the First Hospital of China Medical University between February and April 2021 for external validation. Logistic regression model was used to construct a risk prediction model nomogram. The receiver-operating characteristic (ROC) curve, calibration plot, and decision curve analyses (DCA) were used for assessing the nomogram.

Results: 5,094 patients from the SEER database and 300 patients from our department were finally included in this study. Variables such as age, gender, race, tumor size, multifocality, and minimal extrathyroidal extension (mETE) were found to be associated with CLNM and were subsequently incorporated into our nomogram. The C-index of our constructed model was 0.704, while the internal and external validation C-indexes were 0.693 and 0.745, respectively. The nomogram was then evaluated using calibration and decision curve analyses.

Conclusion: A visualized nomogram was successfully developed to predict CLNM in T1-T2 PTC patients without LLNM and assist clinicians in making personalized clinical decisions.

Keywords: SEER (Surveillance Epidemiology and End Results) database; T1-T2; central lymph mode metastasis; lateral lymph node metastasis; nomogram; papillary thyroid carcinoma (PCT).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient selection in SEER database. AJCC, American Joint Committee on Cancer.
Figure 2
Figure 2
Clinicopathological characteristics-based nomogram used for prediction of CLNM in T1-T2 PTC patients with no LLNM. Other, Asian/Pacific Islander and American Indian/Alaska Native; mETE, minimal extrathyroidal extension; CLNM, central lymph node metastasis; LLNM, lateral lymph node metastases; Age (years); Tumor size (cm).
Figure 3
Figure 3
The receiver operating characteristics (ROC) curve and area under the ROC curve (AUC) in the training cohort, internal cohort, and external cohort. CLNM, central lymph node metastasis.
Figure 4
Figure 4
Calibration plot for our nomogram in the training cohort, internal cohort, and external cohort. CLNM, central lymph node metastasis.
Figure 5
Figure 5
Decision curve analysis for CLNM in T1-T2 PTC patients with no LLNM in the training cohort, internal cohort, and external cohort. Net benefit = (true positives/N) − (false positives/N) * (weighting factor); Weighting factor = Threshold probability/(1−threshold probability); CLNM, central lymph node metastasis; LLNM, lateral lymph node metastases; mETE, minimal extrathyroidal extension.
See this image and copyright information in PMC

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