| Objective To investigate the risk factors for lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma
, and to establish a prediction model and predict the probability of metastasis of the LN-prRLN, which will provide a reference basis for the decision of LN- prRLN clearance. Methods The clinicopathological data of 203 patients who underwent LN-prRLN clearance in the Department of Thyroid and Breast Surgery at the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Traditional Chinese Medicine from May 2023 to May 2024 were retrospectively analysed, and statistically significant risk factors identified by univariate and multivariate analysis were included in the nomogram，then drew the receiver operating characteristic (ROC) curve and the calibration curve to verify the accuracy of the prediction model. Results Univariate analysis showed that age ≤ 55 years, multifocal tumour, maximum tumour diameter > 1 cm, anterior laryngeal lymph node metastasis, lymph node metastasis anterior to the right recurrent laryngeal nerve, right lateral cervical lymph node metastasis uncomplicated Hashimoto"s thyroiditis (HT), extrathyroidal extension, and left central lymph node metastasis were significantly associated with LN-prRLN metastasis. Multifactorial analysis showed that age ≤ 55 years, multifocal tumour, maximum tumour diameter > 1 cm, LN-arRLN metastasis, and extrathyroidal extension were independent risk factors for LN-prRLN metastasis, and combined HT was a protective factor for LN-prRLN metastasis. Based on the above risk factors, a prediction model for LN-prRLN transfer metastasis constructed. The area under the ROC curve was 0.851. The calibration curve showed good agreement between the predicted and observed rates of LN-prRLN metastasis. Conclusion When PTC patients were ≤ 55 years old, had multifocal tumours, tumours with a maximum diameter > 1 cm, LN-arRLN metastasis, and extrathyroidal extension, they had a higher risk of LN-prRLN metastasis, but combined HT was a protective factor for LN-prRLN metastasis. The nomogram based on the above risk factors has good diagnostic efficacy and accuracy, which helps to guide the preoperative assessment of the probability of LN-prRLN metastasis. It is considered to thoroughly clean the LN-prRLN for those with high probability of LN-prRLN metastasis. |
