ZHANG Tianhao 1 , HAO Zhiwei 1 , AN Jie 1 , LI Jin 1 , LI Jinhang 2 , JIANG Zhanwu 1
  • 1. Second Department of General Surgery, Baoding No.1 Central Hospital, Baoding, Hebei 071000, P. R. China;
  • 2. Department of Obstetrics, Baoding No.1 Central Hospital, Baoding, Hebei 071000, P. R. China;
ZHANG Tianhao, Email: zhangtianhao0527@163.com
papillary thyroid carcinoma; lymph nodes posterior to the right recurrent laryngeal nerve; lymph node metastasis; risk factor; prediction model
10.7507/1007-9424.202406016
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Objective To explore the influencing factors affecting lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) and construct a clinical nomogram prediction model to provide a reference for LN-prRLN dissection decision-making. Methods The clinical data of PTC patients admitted to the General Surgery Department of Baoding No.1 Central Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 325 patients underwent LN-prRLN dissection, and they were divided into non-metastatic group (269 cases) and metastasis group (56 cases) according to the presence or absence of LN-prRLN metastasis. By comparing the differences of clinical and pathological characteristics between the two groups, the risk factors of LN-prRLN metastasis were analyzed and discussed, and then the nomogram prediction model of LN-prRLN metastasis was constructed with the risk factors, and the effectiveness of the model was verified and evaluated. Results In 325 patients, 56 cases (17.23%) occurred LN-prRLN metastasis. The results of univariate analysis showed that gender, extrathyroidal extension, lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN) metastasis, location of cancer focus, and lateral lymph node metastasis (LLNM) were related to LN-prRLN metastasis of PTC (P<0.05). Multivariate binary logistic regression analysis showed that male [OR=3.878, 95%CI (1.192, 12.615)], with extrathyroidal extension [OR=2.836, 95%CI (1.036, 7.759)], with LN-arRLN metastasis [OR=10.406, 95%CI (3.225, 33.926)], right cancer focus [OR= 5.632, 95%CI (1.812, 17.504)] and with LLNM [OR=3.426, 95%CI (1.147, 10.231)] were the risk factors of LN-prRLN metastasis. Receiver operating characteristic curves of nomogram prediction model based on the above risk factors showed that the area under the curve was 0.865, 95%CI was (0.795, 0.934), Jordan index was 0.729, sensitivity was 0.873, and specificity was 0.856, which had higher prediction value. The C-index of Bootstrap test was 0.840 [95%CI (0.755, 0.954) ]. Calibration curves showed that predictive value close to the ideal curve, had good consistency. The clinical decision curve analysis showed that the model had good clinical prediction effect on LN-prRLN metastasis of PTC. Conclusions Male, extrathyroidal extension, LN-arRLN metastasis, right cancer focus and LLNM are independent risk factors for LN-prRLN metastasis of PTC. The nomogram prediction model based on the above independent risk factors has high discrimination and calibration, which is helpful for surgeons to make clinical decisions.

Citation： ZHANG Tianhao, HAO Zhiwei, AN Jie, LI Jin, LI Jinhang, JIANG Zhanwu. Construction and verification of nomogram prediction model for risk of posterior lymph node metastasis of right recurrent laryngeal nerve in papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(2): 213-218. doi: 10.7507/1007-9424.202406016 Copy

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