Abstract: Analysis of clinical features and related factors of central cervical lymph node metastasis in pediatric papillary thyroid microcarcinoma        YU Jia-long, LU Xiu-bo, JIA Meng,et al. Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Corresponding authors：LU Xiu-bo, E-mail:doctorluxiubo@126.com; JIA Meng, E-mail:dr_jiameng@163.com
Abstract    Objective    To investigate the risk factors of central cervical lymph node metastasis in pediatric papillary thyroid microcarcinoma, and to construct a nomogram model for predicting cervical lymph node metastasis. Methods    A retrospective analysis was conducted on the data of 184 patients who were diagnosed as thyroid micropapillary carcinoma after pathological examination in the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University from January 1, 2010 to August 31, 2020. According to the postoperative pathological diagnosis evidence, they were divided into cervical lymph node metastasis group(n=114) and no cervical lymph node metastasis group(n=70). The risk factors leading to central cervical lymph node metastasis were analyzed, and the nomogram model of central cervical lymph node metastasis was constructed by R Studio software, and internal verification and external verification were carried out. Results    Univariate analysis shows that central cervical lymph node metastasis is correlated with tumor size，multilocal tumor，number of diseased gland leaves and invasion of capsule. Multivariate analysis shows that the size of tumor＞5 mm, multifocality and invasion of capsule are independent risk factors for central cervical lymph node metastasis. The correlation factors of central cervical lymph node metastasis in the nomogram model includes size of tumor＞5 mm, multifocality and invasion of capsule. The concordance index(c-Index) of the nomogram was 0.882. Conclusion    The size of tumor＞5 mm, multifocality and invasion of capsule are risk factors for central cervical lymph node metastasis of pediatric papillary thyroid microcarcinoma, so the preventive lymph node dissection is recommended.

Key words: children, adolescents, microcarcinoma, lymph node metastasis

摘要： 目的    探讨儿童及青少年甲状腺微小乳头状癌发生颈部中央区淋巴结转移的高危因素，构建预测中央区淋巴结转移的列线图模型。方法    回顾性分析2010-01-01至2020-08-31郑州大学第一附属医院甲状腺外科初治手术治疗并经病理学检查确诊为甲状腺微小乳头状癌的184例儿童及青少年病人资料，根据术后病理检查诊断结果分为颈部淋巴结转移组（114例）和无颈部淋巴结转移组（70例）。分析导致颈部中央区淋巴结转移的相关危险因素，使用R studio软件构建颈部中央区淋巴结转移预测列线图模型，并进行内部验证与外部验证。结果 单因素分析发现颈部中央区淋巴结转移与原发癌灶大小、肿瘤病灶数、病变腺叶数及是否侵犯被膜相关；多因素分析发现癌灶＞5 mm、肿瘤多发、侵犯被膜是颈部中央区淋巴结转移的独立危险因素。列线图模型中颈部中央区淋巴结转移相关因素包括癌灶直径＞5 mm、肿瘤多发、侵犯被摸，一致性指数（c-Index）为0.882。结论    肿瘤原发灶直径＞5 mm、肿瘤多发及侵犯被膜是儿童及青少年甲状腺微小乳头状癌颈部中央区淋巴结转移的危险因素，建议行预防性淋巴结清扫。

关键词: 儿童, 青少年, 甲状腺微小乳头状癌, 淋巴结转移