Background
Methods
Patients
Operation approach
Clinicopathological properties
Statistics analysis
Results
Patients’ characteristics
Risk factors for CLNM
Clinicopathological properties | Central lymph node metastasis | |||||
---|---|---|---|---|---|---|
Total | No | Yes | ||||
Subjects, n | 966 | 599 | 62.0% | 367 | 38.0% | |
Gender | Female | 772 | 496 | 64.2% | 276 | 35.8% |
Male | 194 | 103 | 53.1% | 91 | 46.9% | |
Age (years) | ≤35 | 229 | 97 | 42.4% | 132 | 57.6% |
35–45 | 248 | 146 | 58.9% | 102 | 41.1% | |
45–55 | 273 | 193 | 70.7% | 80 | 29.3% | |
> 55 | 216 | 163 | 75.5% | 53 | 24.5% | |
Tumor size(cm) | ≤0.5 | 178 | 145 | 81.5% | 33 | 18.5% |
0.5–1.0 | 363 | 255 | 70.2% | 108 | 29.8% | |
1.0–2.0 | 275 | 140 | 50.9% | 135 | 49.1% | |
> 2.0 | 150 | 59 | 39.3% | 91 | 60.7% | |
Ultrasound feature | ||||||
Microcalcification | No | 706 | 459 | 65.0% | 247 | 35.0% |
Yes | 260 | 140 | 53.8% | 120 | 46.2% | |
Hypoechoic solid nodules | No | 183 | 112 | 61.2% | 71 | 38.8% |
Yes | 783 | 487 | 62.2% | 296 | 37.8% | |
Irregular shape | No | 631 | 401 | 63.5% | 230 | 36.5% |
Yes | 335 | 198 | 59.1% | 137 | 40.9% | |
Infiltrative margins | No | 252 | 158 | 62.7% | 94 | 37.3% |
Yes | 714 | 441 | 61.8% | 273 | 38.2% | |
Intra-nodular vascularity | No | 328 | 228 | 69.5% | 100 | 30.5% |
Yes | 638 | 371 | 58.2% | 267 | 41.8% | |
Multifocality | No | 679 | 439 | 64.7% | 240 | 35.3% |
Yes | 287 | 160 | 55.7% | 127 | 44.3% | |
Bilateral | No | 767 | 491 | 64.0% | 276 | 36.0% |
Yes | 199 | 108 | 54.3% | 91 | 45.7% | |
Extrathyroidal extension | No | 759 | 500 | 65.9% | 259 | 34.1% |
Yes | 207 | 99 | 47.8% | 108 | 52.2% | |
Distant metastasis | No | 961 | 598 | 62.2% | 363 | 37.8% |
Yes | 5 | 1 | 20.0% | 4 | 80.0% | |
Hashimoto’s thyroiditis | No | 604 | 384 | 63.6% | 220 | 36.4% |
Yes | 362 | 215 | 59.4% | 147 | 40.6% | |
TSH value | 2.10 ± 1.65 | 2.13 ± 1.49 |
OR | 95%CI | P value | |||
---|---|---|---|---|---|
Lower | Upper | ||||
Gender | (male vs. female) | 1.59 | 1.16 | 2.18 | 0.004 |
Age (years) | < 0.001a | ||||
≤35 | 4.19 | 2.79 | 6.28 | < 0.001 | |
35–45 | 2.15 | 1.44 | 3.51 | < 0.001 | |
45–55 | 1.28 | 0.85 | 1.91 | 0.240 | |
> 55 | 1 | ||||
Tumor size(cm) | < 0.001a | ||||
≤0.5 | 1 | ||||
0.5–1.0 | 1.86 | 1.20 | 2.89 | 0.006 | |
1.0–2.0 | 4.24 | 2.71 | 6.62 | < 0.001 | |
> 2.0 | 6.78 | 4.11 | 11.18 | < 0.001 | |
Ultrasound feature | |||||
Microcalcification | (yes vs. no) | 1.59 | 1.19 | 2.13 | 0.002 |
Hypoechoic solid nodules | (yes vs. no) | 0.96 | 0.69 | 1.33 | 0.803 |
Irregular shape | (yes vs. no) | 1.21 | 0.92 | 1.58 | 0.176 |
Infiltrative margins | (yes vs. no) | 1.04 | 0.77 | 1.40 | 0.793 |
Intra-nodular vascularity | (yes vs. no) | 1.64 | 1.24 | 2.18 | 0.001 |
Multifocality | (yes vs. no) | 1.45 | 1.10 | 1.92 | 0.009 |
Bilateral | (yes vs. no) | 1.50 | 1.09 | 2.06 | 0.012 |
Extrathyroidal extension | (yes vs. no) | 2.11 | 1.54 | 2.88 | < 0.001 |
Distant metastasis | (yes vs. no) | 6.59 | 0.73 | 59.19 | 0.092 |
Hashimoto’s thyroiditis | (yes vs. no) | 1.19 | 0.91 | 1.56 | 0.195 |
TSH value | 1.01 | 0.93 | 1.10 | 0.799 |
OR | 95%CI | P value | |||
---|---|---|---|---|---|
Lower | Upper | ||||
Gender | (male vs. female) | 1.48 | 1.04 | 2.11 | 0.028 |
Age (years) | < 0.001a | ||||
≤35 | 4.83 | 3.11 | 7.48 | < 0.001 | |
35–45 | 2.62 | 1.70 | 4.04 | < 0.001 | |
45–55 | 1.50 | 0.97 | 2.32 | 0.066 | |
> 55 | 1 | ||||
Tumor size(cm) | < 0.001a | ||||
≤0.5 | 1 | ||||
0.5–1.0 | 1.55 | 0.98 | 2.46 | 0.060 | |
1.0–2.0 | 3.22 | 2.00 | 5.18 | < 0.001 | |
> 2.0 | 4.85 | 2.81 | 8.35 | < 0.001 | |
Microcalcification | (yes vs. no) | 1.43 | 1.04 | 1.97 | 0.029 |
Intra-nodular vascularity | (yes vs. no) | 1.30 | 0.95 | 1.78 | 0.100 |
Multifocality | (yes vs. no) | 0.96 | 0.59 | 1.59 | 0.886 |
Bilateral | (yes vs. no) | 1.39 | 0.80 | 2.41 | 0.242 |
Extrathyroidal extension | (yes vs. no) | 1.68 | 1.18 | 2.39 | 0.004 |
Risk factors for LLNM
Clinicopathological properties | Lateral lymph node metastasis | |||||
---|---|---|---|---|---|---|
Total | No | Yes | ||||
Subjects, n | 420 | 209 | 49.8% | 211 | 50.2% | |
Gender | Female | 329 | 172 | 52.3% | 157 | 47.7% |
Male | 91 | 37 | 40.7% | 54 | 59.3% | |
Age (years) | ≤35 | 121 | 48 | 39.7% | 73 | 60.3% |
35–45 | 104 | 52 | 50.0% | 52 | 50.0% | |
45–55 | 108 | 56 | 51.9% | 52 | 48.1% | |
> 55 | 87 | 53 | 60.9% | 34 | 39.1% | |
Tumor size(cm) | ≤0.5 | 35 | 24 | 68.6% | 11 | 31.4% |
0.5–1.0 | 137 | 82 | 59.9% | 55 | 40.1% | |
1.0–2.0 | 147 | 69 | 46.9% | 78 | 53.1% | |
> 2.0 | 101 | 34 | 33.7% | 67 | 66.3% | |
Ultrasound feature | ||||||
Microcalcification | No | 277 | 144 | 52.0% | 133 | 48.0% |
Yes | 143 | 65 | 45.5% | 78 | 54.5% | |
Hypoechoic solid nodules | No | 73 | 33 | 45.2% | 40 | 54.8% |
Yes | 347 | 176 | 50.7% | 171 | 49.3% | |
Irregular shape | No | 259 | 131 | 50.6% | 128 | 49.4% |
Yes | 161 | 78 | 48.4% | 83 | 51.6% | |
Infiltrative margins | No | 95 | 48 | 50.5% | 47 | 49.5% |
Yes | 325 | 161 | 49.5% | 164 | 50.5% | |
Intra-nodular vascularity | No | 114 | 57 | 50.0% | 57 | 50.0% |
Yes | 306 | 152 | 49.7% | 154 | 50.3% | |
Multifocality | No | 272 | 142 | 52.2% | 130 | 47.8% |
Yes | 148 | 67 | 45.3% | 81 | 54.7% | |
Bilateral | No | 315 | 163 | 51.7% | 152 | 48.3% |
Yes | 105 | 46 | 43.8% | 59 | 56.2% | |
Extrathyroidal extension | No | 286 | 153 | 53.5% | 133 | 46.5% |
Yes | 134 | 56 | 41.8% | 78 | 58.2% | |
Distant metastasis | No | 416 | 207 | 49.8% | 209 | 50.2% |
Yes | 4 | 2 | 50.0% | 2 | 50.0% | |
Hashimoto’s thyroiditis | No | 251 | 130 | 51.8% | 121 | 48.2% |
Yes | 169 | 79 | 46.7% | 90 | 53.3% | |
The number of CLNM | 0 | 186 | 130 | 69.9% | 56 | 30.1% |
1–3 > 3 | 165 69 | 68 11 | 41.2% 15.9% | 97 58 | 58.8% 84.1% | |
TSH value | 2.20 ± 1.66 | 2.16 ± 1.44 |
OR | 95%CI | P value | |||
---|---|---|---|---|---|
Lower | Upper | ||||
Gender | (male vs. female) | 1.60 | 1.00 | 2.56 | 0.051 |
Age (years) | 0.025a | ||||
≤35 | 2.37 | 1.35 | 4.17 | 0.003 | |
35–45 | 1.56 | 0.88 | 2.78 | 0.132 | |
45–55 | 1.45 | 0.82 | 2.57 | 0.206 | |
> 55 | 1 | ||||
Tumor size(cm) | < 0.001a | ||||
≤0.5 | 1 | ||||
0.5–1.0 | 1.46 | 0.66 | 3.23 | 0.346 | |
1.0–2.0 | 2.47 | 1.13 | 5.40 | 0.024 | |
> 2.0 | 4.30 | 1.89 | 9.81 | 0.001 | |
Ultrasound feature | |||||
Microcalcification | (yes vs. no) | 1.30 | 0.87 | 1.95 | 0.205 |
Hypoechoic solid nodules | (yes vs. no) | 0.80 | 0.48 | 1.33 | 0.392 |
Irregular shape | (yes vs. no) | 1.09 | 0.74 | 1.61 | 0.671 |
Infiltrative margins | (yes vs. no) | 1.04 | 0.66 | 1.64 | 0.865 |
Intra-nodular vascularity | (yes vs. no) | 1.01 | 0.66 | 1.56 | 0.953 |
Multifocality | (yes vs. no) | 1.32 | 0.88 | 1.97 | 0.175 |
Bilateral | (yes vs. no) | 1.38 | 0.88 | 2.15 | 0.160 |
Extrathyroidal extension | (yes vs. no) | 1.60 | 1.06 | 2.43 | 0.026 |
Distant metastasis | (yes vs. no) | 0.99 | 1.38 | 7.10 | 0.992 |
Hashimoto’s thyroiditis | (yes vs. no) | 1.22 | 0.83 | 1.81 | 0.311 |
The number of CLNM | < 0.001a | ||||
0 | 1 | ||||
1–3 | 3.31 | 2.13 | 5.15 | < 0.001 | |
> 3 | 12.24 | 5.98 | 25.06 | < 0.001 | |
TSH value | 0.98 | 0.86 | 1.11 | 0.711 |
OR | 95%CI | P value | |||
---|---|---|---|---|---|
Lower | Upper | ||||
Age (years) | 0.447a | ||||
≤35 | 1.64 | 0.87 | 3.09 | 0.125 | |
35–45 | 1.26 | 0.66 | 2.40 | 0.478 | |
45–55 | 1.46 | 0.78 | 2.75 | 0.236 | |
> 55 | 1 | ||||
Tumor size(cm) | 0.060a | ||||
≤0.5 | 1 | ||||
0.5–1.0 1.0–2.0 | 1.57 1.94 | 0.67 0.84 | 3.63 4.51 | 0.297 0.121 | |
> 2.0 | 3.03 | 1.24 | 7.44 | 0.015 | |
Extrathyroidal extension | (yes vs. no) | 1.26 | 0.78 | 2.02 | 0.350 |
The number of CLNM | < 0.001a | ||||
0 | 1 | ||||
1–3 | 2.96 | 1.87 | 4.70 | < 0.001 | |
> 3 | 9.27 | 4.38 | 19.63 | < 0.001 |
The features of the LLNM
The sites of lateral compartment | Lateral lymph node metastasis | Positive rate |
χ
2
| P value | |
---|---|---|---|---|---|
No | yes | ||||
123. 60 | < 0.001 | ||||
Level II | 122 | 89 | 42.2% | < 0.001a, < 0.001b, 0.918c | |
Level III | 70 | 141 | 66.8% | < 0.001d, < 0.001e, < 0.001f | |
Level IV | 69 | 142 | 67.3% | ||
Level V | 166 | 45 | 21.3% |
Tumor location | lateral lymph node metastasis | Positive rate |
χ
2
| P value | |
---|---|---|---|---|---|
No | Yes | ||||
11.423 | 0.022 | ||||
Upper 1/3 of the lobe | 38 | 57 | 60.0% | ||
Middle 1/3 of the lobe | 34 | 20 | 37.0% | ||
Lower 1/3 of the lobe | 47 | 29 | 38.2% | ||
Isthmus | 14 | 13 | 48.1% | ||
Whole | 9 | 11 | 5.5% |
Tumor location | The site of lateral lymph node metastasis |
χ
2
| P value | |||
---|---|---|---|---|---|---|
Level II | Level III | Level IV | Level V | |||
9.621 | 0.649 | |||||
Upper 1/3 of the lobe (n = 57 cases) | 34 | 38 | 36 | 15 | ||
Middle 1/3 of the lobe (n = 20 cases) | 5 | 10 | 18 | 5 | ||
Lower 1/3 of the lobe (n = 29 cases) | 8 | 16 | 19 | 5 | ||
Isthmus (n = 13 cases) | 3 | 8 | 10 | 2 | ||
Whole (n = 11 cases) | 4 | 7 | 10 | 2 |
Tumor location | Skip metastasis | Metastasis rate |
χ
2
| P value | |
---|---|---|---|---|---|
No | Yes | ||||
11.124 | 0.021 | ||||
Upper 1/3 of the lobe | 35 | 22 | 38.6% | ||
Middle 1/3 of the lobe | 18 | 2 | 10.0% | ||
Lower 1/3 of the lobe | 21 | 8 | 27.6% | ||
Isthmus | 9 | 4 | 30.8% | ||
Whole | 11 | 0 | 0% |
Tumor location | The site of skip metastasis |
χ
2
| P value | |||
---|---|---|---|---|---|---|
Level II | Level III | Level IV | Level V | |||
6.689 | 0.674 | |||||
Upper 1/3 of the lobe (n = 22 cases) | 15 | 10 | 11 | 3 | ||
Middle 1/3 of the lobe (n = 2 cases) | 1 | 1 | 2 | 1 | ||
Lower 1/3 of the lobe (n = 8 cases) | 1 | 2 | 4 | 2 | ||
Isthmus (n = 4 cases) | 1 | 1 | 3 | 1 |