Analysis of risk factors for central and lateral lymph node metastasis in patients with papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WU Yayun ,  ZHANG Kai , CAO Zhimin , DENG Jinbei , LIU Rubin , ZHANG Qiang

Department of Head and Neck Surgery, Fuyang Cancer Hospital, Fuyang, Anhui 236000, P. R. China;

Corresponding author：

WU Yayun, Email: wuyayun@mzdan.com; ZHANG Kai, Email: zhangkai@mzdan.com

Keywords：

papillary thyroid carcinoma; central lymph node metastasis; lateral lymph node metastasis; risk factor

DOI：

10.7507/1007-9424.202411150

Video：

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Objective To investigate the risk factors affecting on cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). Methods The patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors influencing the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally,the discriminatory power of the predictive model for CLNM and LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). Results A total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral (or isthmus) cancer foci, maximum tumor diameter >5 mm, and invasion of the capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk-associated factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, unilateral/bilateral (or isthmus), maximum tumor diameter, and capsular invasion], the AUC (95% CI) was 0.776 (0.707, 0.846).Conclusions The data indicate that PTC patients with maximum tumor diameter (>5 mm) and young (age <36 years old) male characteristics exhibite a higher risk of CLNM, patients with maximum tumor diameter (>5 mm), capsular invasion, bilateral (or isthmus) cancer foci, and elderly (age ≥59 years old) characteristics exhibite a higher risk of LLNM.

1.	姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
2.	中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版). 中华内分泌代谢杂志, 2023, 39(3): 181-226.
3.	何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005–2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
4.	Wang Z, Gui Z, Wang Z, et al. Clinical and ultrasonic risk factors for high-volume central lymph node metastasis in cN0 papillary thyroid microcarcinoma: A retrospective study and meta-analysis. Clin Endocrinol (Oxf), 2023, 98(4): 609-621.
5.	Lou J, Yang J, Luo Y, et al. Analysis of the influence factors of cervical lymph node metastasis in papillary thyroid carcinoma: A retrospective observational study. Medicine (Baltimore), 2023, 102(36): e35045. doi: 10.1097/MD.0000000000035045.
6.	Cai H, Zhuge L, Huang Z, et al. Distinct risk factors of lateral lymph node metastasis in patients with papillary thyroid cancer based on age stratification. BMC Surg, 2024, 24(1): 24. doi: 10.1186/s12893-024-02309-2.
7.	Du J, Yang Q, Sun Y, et al. Risk factors for central lymph node metastasis in patients with papillary thyroid carcinoma: a retrospective study. Front Endocrinol (Lausanne), 2023, 14: 1288527. doi: 10.3389/fendo.2023.1288527.
8.	Shao L, Wang Z, Dong W, et al. Risk factors associated with preferential lateral lymph node metastasis in papillary thyroid carcinoma. Cancer Med, 2023, 12(22): 20670-20676.
9.	Huang W, Chen D, Zhong M, et al. Factors of central lymph node metastasis in papillary thyroid cancer based on C-TIRADS analysis. Horm Metab Res, 2023, 55(9): 585-591.
10.	Liu J, Guo M. Clinical analysis of cervical lymph node metastasis patterns and multivariate factors in differentiated thyroid carcinoma. Oncol Lett, 2023, 26(4): 431. doi: 10.3892/ol.2023.14018.
11.	Muhanhali D, Deng L, Ai Z, et al. Impaired thyroid hormone sensitivity increases the risk of papillary thyroid cancer and cervical lymph node metastasis. Endocrine, 2024, 83(3): 659-670.
12.	Chang L, Zhang Y, Zhu J, et al. An integrated nomogram combining deep learning, clinical characteristics and ultrasound features for predicting central lymph node metastasis in papillary thyroid cancer: A multicenter study. Front Endocrinol (Lausanne), 2023, 14: 964074. doi: 10.3389/fendo.2023.964074.
13.	Lim ST, Jeon YW, Suh YJ. Correlation between surgical extent and prognosis in node-negative, early-stage papillary thyroid carcinoma originating in the isthmus. World J Surg, 2016, 40(2): 344-349.
14.	American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 2009, 19(11): 1153-1158.
15.	Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules—2016 update appendix. Endocr Pract, 2016, 22(5): 622-639.
16.	Jiwang L, Jinghui B, Fengqin F, et al. Comprehensive analysis of clinicopathologic and sonographic features in thyroid cancer with skip lymph node metastasis: establish and assessment of a prediction nomogram. Braz J Otorhinolaryngol, 2023, 89(5): 101301. doi: 10.1016/j.bjorl.2023.101301.
17.	Wu WX, Qi GF, Feng JW, et al. Construction of prediction models for determining the risk of lateral lymph node metastasis in patients with thyroid papillary carcinoma based on gender stratification. Eur Arch Otorhinolaryngol, 2023, 280(5): 2511-2523.
18.	Guo P, Wang X, Xia L, et al. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med, 2023, 12(7): 7868-7876.
19.	康韶洋, 胡晓东, 聂智梅, 等. 甲状腺乳头状癌颈部淋巴结转移的危险因素分析—单中心回顾性研究. 解放军医学杂志, 2023, 48(5): 510-515.
20.	Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
21.	刘晓楠, 邸旭, 张强, 等. 低风险甲状腺微小乳头状癌的诊治进展. 中国实用外科杂志, 2023, 43(2): 231-234.
22.	Abood A, Ovesen T, Rolighed L, et al. Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution. Front Endocrinol (Lausanne), 2024, 15: 1330524. doi: 10.3389/fendo.2024.1330524.
23.	Best CAE, Hussain J, Johnson-Obaseki S. Alternative sources of cautery in thyroid surgery and the risk of recurrent laryngeal nerve injury: A retrospective, risk-adjusted analysis from the national surgical quality improvement program. J Otolaryngol Head Neck Surg, 2024, 53: 19160216241265687. doi: 10.1177/19160216241265687.
24.	Hassan I, Hassan L, Bacha F, et al. Clinico-pathological initial outcome of a newly adopted novel surgical technique for nodal metastatic thyroid cancer at a large-volume centre in a high-income developing country. Front Surg, 2023, 10: 1204230. doi: 10.3389/fsurg.2023.1204230.
25.	Santamaria-Barria JA, Graff-Baker AN, Chang SC, et al. Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes. Head Neck, 2022, 44(10): 2129-2141.
26.	Qi GF, Feng JW, Wu WX, et al. Construction of a nomogram for central lymph node metastasis in papillary thyroid cancer based on gender grouping. Eur Arch Otorhinolaryngol, 2024, 281(2): 965-975.
27.	Liu W, Zhang D, Jiang H, et al. Prediction model of cervical lymph node metastasis based on clinicopathological characteristics of papillary thyroid carcinoma: a dual-center retrospective study. Front Endocrinol (Lausanne), 2023, 14: 1233929. doi: 10.3389/fendo.2023.1233929.
28.	Kwon O, Lee S, Bae JS. Risk factors associated with high-risk nodal disease in patients considered for active surveillance of papillary thyroid microcarcinoma without extrathyroidal extension. Gland Surg, 2023, 12(9): 1179-1190.
29.	Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
30.	Nguyen BQ, Vu HT, Nguyen LMT, et al. Clinicopathologic characteristics of thyroid microcarcinoma: Findings from a hospital-based study in Vietnam. Discov Med, 2024, 36(180): 209-216.
31.	Ngo DQ, Le DT, Ngo QX, et al. Risk factors for lateral lymph node metastasis of papillary thyroid carcinoma in children. J Pediatr Surg, 2022, 57(10): 421-424.
32.	Liu W, Wang S, Xia X, et al. A proposed heterogeneous ensemble algorithm model for predicting central lymph node metastasis in papillary thyroid cancer. Int J Gen Med, 2022, 15: 4717-4732.
33.	Jin L, Zheng D, Mo D, et al. Glucose-to-lymphocyte Ratio (GLR) as a predictor of preoperative central lymph node metastasis in papillary thyroid cancer patients with type 2 diabetes mellitus and construction of the nomogram. Front Endocrinol (Lausanne), 2022, 13: 829009. doi: 10.3389/fendo.2022.829009.
34.	Zhang T, He L, Wang Z, et al. Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer. Front Oncol, 2022, 12: 1003336. doi: 10.3389/fonc.2022.1003336.
35.	Zheng H, Lai V, Lu J, et al. Clinical factors predictive of lymph node metastasis in thyroid cancer patients: a multivariate analysis. J Am Coll Surg, 2022, 234(4): 691-700.
36.	Elbasan O, Ilgın C, Gogas Yavuz D. Does total tumour diameter, multifocality, number of tumour foci, or laterality predict lymph node metastasis or recurrence in differentiated thyroid cancer?. Endokrynol Pol, 2023, 74(2): 153-167.
37.	Han Y, Hou L, Zhao B, et al. Risk factors for neck nodal metastasis in papillary thyroid cancer with BRAFV600E mutation. Front Endocrinol (Lausanne), 2022, 13: 884428. doi: 10.3389/fendo.2022.884428.
38.	Feng JW, Wu WX, Qi GF, et al. Nomograms based on sonographic and clinicopathological characteristics to predict lateral lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest, 2022, 45(11): 2043-2057.
39.	Cui L, Feng D, Zhu C, et al. Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol, 2022, 7(4): 1224-1234.
40.	Wei B, Yao J, Peng C, et al. Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma. BMC Cancer, 2023, 23(1): 1225. doi: 10.1186/s12885-023-11721-5.
41.	Ozdemir K, Harmantepe AT, Gonullu E, et al. Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?. Updates Surg, 2023, 75(3): 701-706.
42.	Ye L, Hu L, Liu W, et al. Capsular extension at ultrasound is associated with lateral lymph node metastasis in patients with papillary thyroid carcinoma: A retrospective study. BMC Cancer, 2021, 21(1): 1250. doi: 10.1186/s12885-021-08875-5.
43.	Sun W, Zheng B, Wang Z, et al. Meta-analysis of risk factors for CCLNM in patients with unilateral cN0 PTC. Endocr Connect, 2020, 9(5): 387-395.
44.	Guo K, Qian K, Shi Y, et al. Clinical and molecular characterizations of papillary thyroid cancer in children and young adults: A multicenter retrospective study. Thyroid, 2021, 31(11): 1693-1706.
45.	Dong Y, Wang D, Luo Y, et al. Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma. Oncol Lett, 2021, 21(3): 188. doi: 10.3892/ol.2021.12449.
46.	Shi P, Yang D, Liu Y, et al. A protective factor against lymph node metastasis of papillary thyroid cancer: Female gender. Auris Nasus Larynx, 2023, 50(3): 440-449.
47.	Li R, Hao J, Zhu Z, et al. Correlation between US-FNAC with BRAFV600E mutation analysis and central neck lymph node metastasis in cN0 papillary thyroid cancer. Biomed Res Int, 2021, 2021: 9937742. doi: 10.1155/2021/9937742.

1. 姚一菲, 孙可欣, 郑荣寿. 《2022全球癌症统计报告》解读: 中国与全球对比. 中国普外基础与临床杂志, 2024, 31(7): 769-780.
2. 中华医学会内分泌学分会, 中华医学会外科学分会甲状腺及代谢外科学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版). 中华内分泌代谢杂志, 2023, 39(3): 181-226.
3. 何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005–2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
4. Wang Z, Gui Z, Wang Z, et al. Clinical and ultrasonic risk factors for high-volume central lymph node metastasis in cN0 papillary thyroid microcarcinoma: A retrospective study and meta-analysis. Clin Endocrinol (Oxf), 2023, 98(4): 609-621.
5. Lou J, Yang J, Luo Y, et al. Analysis of the influence factors of cervical lymph node metastasis in papillary thyroid carcinoma: A retrospective observational study. Medicine (Baltimore), 2023, 102(36): e35045. doi: 10.1097/MD.0000000000035045.
6. Cai H, Zhuge L, Huang Z, et al. Distinct risk factors of lateral lymph node metastasis in patients with papillary thyroid cancer based on age stratification. BMC Surg, 2024, 24(1): 24. doi: 10.1186/s12893-024-02309-2.
7. Du J, Yang Q, Sun Y, et al. Risk factors for central lymph node metastasis in patients with papillary thyroid carcinoma: a retrospective study. Front Endocrinol (Lausanne), 2023, 14: 1288527. doi: 10.3389/fendo.2023.1288527.
8. Shao L, Wang Z, Dong W, et al. Risk factors associated with preferential lateral lymph node metastasis in papillary thyroid carcinoma. Cancer Med, 2023, 12(22): 20670-20676.
9. Huang W, Chen D, Zhong M, et al. Factors of central lymph node metastasis in papillary thyroid cancer based on C-TIRADS analysis. Horm Metab Res, 2023, 55(9): 585-591.
10. Liu J, Guo M. Clinical analysis of cervical lymph node metastasis patterns and multivariate factors in differentiated thyroid carcinoma. Oncol Lett, 2023, 26(4): 431. doi: 10.3892/ol.2023.14018.
11. Muhanhali D, Deng L, Ai Z, et al. Impaired thyroid hormone sensitivity increases the risk of papillary thyroid cancer and cervical lymph node metastasis. Endocrine, 2024, 83(3): 659-670.
12. Chang L, Zhang Y, Zhu J, et al. An integrated nomogram combining deep learning, clinical characteristics and ultrasound features for predicting central lymph node metastasis in papillary thyroid cancer: A multicenter study. Front Endocrinol (Lausanne), 2023, 14: 964074. doi: 10.3389/fendo.2023.964074.
13. Lim ST, Jeon YW, Suh YJ. Correlation between surgical extent and prognosis in node-negative, early-stage papillary thyroid carcinoma originating in the isthmus. World J Surg, 2016, 40(2): 344-349.
14. American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid, 2009, 19(11): 1153-1158.
15. Gharib H, Papini E, Garber JR, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules—2016 update appendix. Endocr Pract, 2016, 22(5): 622-639.
16. Jiwang L, Jinghui B, Fengqin F, et al. Comprehensive analysis of clinicopathologic and sonographic features in thyroid cancer with skip lymph node metastasis: establish and assessment of a prediction nomogram. Braz J Otorhinolaryngol, 2023, 89(5): 101301. doi: 10.1016/j.bjorl.2023.101301.
17. Wu WX, Qi GF, Feng JW, et al. Construction of prediction models for determining the risk of lateral lymph node metastasis in patients with thyroid papillary carcinoma based on gender stratification. Eur Arch Otorhinolaryngol, 2023, 280(5): 2511-2523.
18. Guo P, Wang X, Xia L, et al. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med, 2023, 12(7): 7868-7876.
19. 康韶洋, 胡晓东, 聂智梅, 等. 甲状腺乳头状癌颈部淋巴结转移的危险因素分析—单中心回顾性研究. 解放军医学杂志, 2023, 48(5): 510-515.
20. Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576.
21. 刘晓楠, 邸旭, 张强, 等. 低风险甲状腺微小乳头状癌的诊治进展. 中国实用外科杂志, 2023, 43(2): 231-234.
22. Abood A, Ovesen T, Rolighed L, et al. Hypoparathyroidism following total thyroidectomy: high rates at a low-volume, non-parathyroid institution. Front Endocrinol (Lausanne), 2024, 15: 1330524. doi: 10.3389/fendo.2024.1330524.
23. Best CAE, Hussain J, Johnson-Obaseki S. Alternative sources of cautery in thyroid surgery and the risk of recurrent laryngeal nerve injury: A retrospective, risk-adjusted analysis from the national surgical quality improvement program. J Otolaryngol Head Neck Surg, 2024, 53: 19160216241265687. doi: 10.1177/19160216241265687.
24. Hassan I, Hassan L, Bacha F, et al. Clinico-pathological initial outcome of a newly adopted novel surgical technique for nodal metastatic thyroid cancer at a large-volume centre in a high-income developing country. Front Surg, 2023, 10: 1204230. doi: 10.3389/fsurg.2023.1204230.
25. Santamaria-Barria JA, Graff-Baker AN, Chang SC, et al. Disparities in the impact of the AJCC 8th edition staging system on differentiated thyroid cancer outcomes. Head Neck, 2022, 44(10): 2129-2141.
26. Qi GF, Feng JW, Wu WX, et al. Construction of a nomogram for central lymph node metastasis in papillary thyroid cancer based on gender grouping. Eur Arch Otorhinolaryngol, 2024, 281(2): 965-975.
27. Liu W, Zhang D, Jiang H, et al. Prediction model of cervical lymph node metastasis based on clinicopathological characteristics of papillary thyroid carcinoma: a dual-center retrospective study. Front Endocrinol (Lausanne), 2023, 14: 1233929. doi: 10.3389/fendo.2023.1233929.
28. Kwon O, Lee S, Bae JS. Risk factors associated with high-risk nodal disease in patients considered for active surveillance of papillary thyroid microcarcinoma without extrathyroidal extension. Gland Surg, 2023, 12(9): 1179-1190.
29. Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid, 2014, 24(1): 27-34.
30. Nguyen BQ, Vu HT, Nguyen LMT, et al. Clinicopathologic characteristics of thyroid microcarcinoma: Findings from a hospital-based study in Vietnam. Discov Med, 2024, 36(180): 209-216.
31. Ngo DQ, Le DT, Ngo QX, et al. Risk factors for lateral lymph node metastasis of papillary thyroid carcinoma in children. J Pediatr Surg, 2022, 57(10): 421-424.
32. Liu W, Wang S, Xia X, et al. A proposed heterogeneous ensemble algorithm model for predicting central lymph node metastasis in papillary thyroid cancer. Int J Gen Med, 2022, 15: 4717-4732.
33. Jin L, Zheng D, Mo D, et al. Glucose-to-lymphocyte Ratio (GLR) as a predictor of preoperative central lymph node metastasis in papillary thyroid cancer patients with type 2 diabetes mellitus and construction of the nomogram. Front Endocrinol (Lausanne), 2022, 13: 829009. doi: 10.3389/fendo.2022.829009.
34. Zhang T, He L, Wang Z, et al. Risk factors of cervical lymph node metastasis in multifocal papillary thyroid cancer. Front Oncol, 2022, 12: 1003336. doi: 10.3389/fonc.2022.1003336.
35. Zheng H, Lai V, Lu J, et al. Clinical factors predictive of lymph node metastasis in thyroid cancer patients: a multivariate analysis. J Am Coll Surg, 2022, 234(4): 691-700.
36. Elbasan O, Ilgın C, Gogas Yavuz D. Does total tumour diameter, multifocality, number of tumour foci, or laterality predict lymph node metastasis or recurrence in differentiated thyroid cancer?. Endokrynol Pol, 2023, 74(2): 153-167.
37. Han Y, Hou L, Zhao B, et al. Risk factors for neck nodal metastasis in papillary thyroid cancer with BRAFV600E mutation. Front Endocrinol (Lausanne), 2022, 13: 884428. doi: 10.3389/fendo.2022.884428.
38. Feng JW, Wu WX, Qi GF, et al. Nomograms based on sonographic and clinicopathological characteristics to predict lateral lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest, 2022, 45(11): 2043-2057.
39. Cui L, Feng D, Zhu C, et al. Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol, 2022, 7(4): 1224-1234.
40. Wei B, Yao J, Peng C, et al. Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma. BMC Cancer, 2023, 23(1): 1225. doi: 10.1186/s12885-023-11721-5.
41. Ozdemir K, Harmantepe AT, Gonullu E, et al. Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?. Updates Surg, 2023, 75(3): 701-706.
42. Ye L, Hu L, Liu W, et al. Capsular extension at ultrasound is associated with lateral lymph node metastasis in patients with papillary thyroid carcinoma: A retrospective study. BMC Cancer, 2021, 21(1): 1250. doi: 10.1186/s12885-021-08875-5.
43. Sun W, Zheng B, Wang Z, et al. Meta-analysis of risk factors for CCLNM in patients with unilateral cN0 PTC. Endocr Connect, 2020, 9(5): 387-395.
44. Guo K, Qian K, Shi Y, et al. Clinical and molecular characterizations of papillary thyroid cancer in children and young adults: A multicenter retrospective study. Thyroid, 2021, 31(11): 1693-1706.
45. Dong Y, Wang D, Luo Y, et al. Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma. Oncol Lett, 2021, 21(3): 188. doi: 10.3892/ol.2021.12449.
46. Shi P, Yang D, Liu Y, et al. A protective factor against lymph node metastasis of papillary thyroid cancer: Female gender. Auris Nasus Larynx, 2023, 50(3): 440-449.
47. Li R, Hao J, Zhu Z, et al. Correlation between US-FNAC with BRAFV600E mutation analysis and central neck lymph node metastasis in cN0 papillary thyroid cancer. Biomed Res Int, 2021, 2021: 9937742. doi: 10.1155/2021/9937742.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesAnalysis of risk factors for central and lateral lymph node metastasis in patients with papillary thyroid carcinoma

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