Risk Predictors For Central Lymph Node Metastasis And Recurrence In Cno Papillary Thyroid Microcarcinoma

Surgical management of papillary thyroid microcarcinoma (PTMC), especially the need for central lymph node dissection, remains controversial. This study evaluated candidate risk factors of central lymph node metastasis (CLNM) to predict high-risk groups of CLNM from PTMC patients. Multivariate logistic regression analysis was used for 3,132 PTMC patients, who were surgically treated between 2005 and 2014, to determine the association of clinicopathologic factors and CLNM. A Cox regression model was used to determine the prognostic factors of recurrence. According to the results, CLNM was detected in 28.83% (903/3132) of the patients and 26.41% (956/3620) of the lesions. In multivariate analysis, males, age <= 35 years, with tumor size > 0.5 cm, lobe dissemination (+), psammoma body (+), capsular invasion (+), and multifocality were independent risk factors of CLNM. A nearly linear correlation was found between the CLNM rate and the tumor size in 10 groups (y = 0.040x + 0.035; R-2 = 0.970). A Cox regression model showed that tumor size > 0.5 cm, lobe dissemination (+), psammoma body (+), bilaterality (+), and CLNM were risk predictors of recurrence. In conclusion, due to the prevalence of CLNM in PTMC patients, we suggest that prophylactic CLN dissection could be performed routinely in CN0 PTMC patients, especially patients with the following factors: male, age <= 35 years, tumor size > 0.5 cm, lobe dissemination (+), psammoma body (+), capsular invasion (+), and multifocality, and more frequent follow-up should be considered for patients with tumor size > 0.5 cm, lobe dissemination (+), psammoma body (+), bilaterality (+), and CLNM.