Correlation analysis of risk factors for cervical lymphatic metastasis in papillary thyroid carcinoma

Objective: To analyse the risk factors of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). Methods: The clinicopathological data of 2384 PTC patients admitted to our hospital from January 2016 to December 2020 were retrospectively analysed. The risk factors for cervical lymph node metastasis of PTC were also analysed. Results: Male ( OR =1.564, 95% CI : 1.138-2.148, P < 0.001), age ≤55 years old ( OR =2.874, 95% C I:1.600-5.161, P < 0.001), tumor lesion > 0.5cm ( OR =1.777, 95% CI: 1.289-2.448, P <0.001), Multifocal ( OR =0.686, 95% CI :0.531- 0.886, P < 0.001) were risk factors for central lymph node metastasis (CLNM). ROC curve showed that the cutoff value of tumor lesion size for predicting CLNM was 0.855 (sensitivity was 57.9%, specificity was 69%, AUC was 0.269, P < 0.05). The metastatic rate of lateral cervical lymph nodes increased with the increase of tumor diameter. Lateral cervical lymph node metastasis (LLNM) was more common in area III (59.4%) and Ⅳ (53.1%) than Ⅴ (9.4%) ( P < 0.008). The metastasis rate of area II was 40.6%, and there was no significant difference between the two regions. In this study, a total of 85 PTC patients were tested for BRAF gene, and 79 of them were found to have BRAF gene mutations, with a mutation rate of 93%. BRAF gene mutation is of certain value for the diagnosis of PTC, but there is no statistical significance for the assessment of CLNM ( P =0.827). Conclusion: CLNM in PTC patients is significantly related to male patients age ≤55 years old with tumor lesions > 0.855cm and multiple tumor lesions. Central lymph node dissection (CLND) should be performed actively for those patients. The lateral neck lymph node metastasis should be evaluated in detail before surgery. And areas Ⅱ, Ⅲ and Ⅳ should be the main focus if they need to be cleaned. Areas I and V were cleaned according to other risk factors of the patients.