Clinical analysis of risk factors for lateral cervical lymph node metastasis in stage cN0 papillary thyroid carcinoma and preventive dissection

Objective To discuss the clinical characteristics for lateral cervical lymph node metastasis in stage cN0 papillary thyroid microcarcinoma and significance and feasibility of preventive dissection, and provide reference for clinical treatment. Methods Reviewd the clinical data of 191 patients with stage cN0 papillary thyroid microcarcinoma patients from Jul. 2011 to Dec. 2016 underwent surgery in the Department of General Surgery of Lianyungang Oriental Hospital. Assessed the need for preventive cervical lymph node dissection.Chi-square test and logistic regression were used to analyze the relationship between cervical lymph node metastasis and gender, age, tumor number, tumor size, capsule infiltration, single and bilateral tumors, Hashimoto′s disease, and central lymph node metastasis. Results The positive rate of cervical lymph node metastasis in papillary thyroid microcarcinoma was 27.9% (50/191). Univariate analysis showed that the metastasis of the cervical lymph nodes was associated with infiltration of the capsule, Hashimoto disease, and CLN metastasis (all P<0.05). Multivariate logistic regression analysis showed that the capsule infiltration (OR=7.563, P=0.000), Hashimoto′s disease (OR=4.635, P=0.003), and central lymph node metastasis (OR=3.075, P<0.001) were able to be independent risk factors for cervical lymph node metastasis. When the positive number of lymph node metastasis in the central region was ≥ 2, the positive rate of cervical lymph nodes was significantly increased (P<0.001). Eleven patients (5.8%) had temporary recurrent laryngeal nerve palsy, 29 patients (15.1%) had transient hypoparathyroidism, and no patients with permanent recurrent laryngeal nerve palsy and hypoparathyroidism. Conclusions The removal of the cervical lymph nodes helps to accurately classify the tumor and assess the risk.It is important to choose the postoperative treatment follow-up plan for patients.For patients with capsule infiltration, Hashimoto′s disease, and central lymph node metastasis, cervical lymph node dissection should be routinely performed. Key words: Surgical procedures, operative; Parathyroid glands; Neck dissection; Papillary thyroid microcarcinoma; Prophylactic lateral cervical lymph node dissection