In cN1b PTMC, SLNM is independently associated with tumor size ≤ 5 mm and absence of intrathyroidal dissemination but not with recurrence or DSS, suggesting it should be a key target for preoperative imaging evaluation rather than a poor prognostic factor. ETE is one of the most important independent recurrence risk factors, alongside upper-pole location and intrathyroidal dissemination-its effect magnitude requires cautious interpretation due to a wide confidence interval. A risk-stratified strategy is supported: patients with these high-risk features may consider more radical treatment and intensified postoperative surveillance. This study provides evidence-based guidance to improve disease-free survival in cN1b PTMC patients.
Zhu et al. (Thu,) studied this question.