Intraglandular dissemination is a risk factor for lymph node metastasis in papillary thyroid carcinoma: a propensity score matching analysis

Bei Qian; Shuang Guo; Jun Zhou; Xincai Qu; Shoupeng Zhang

doi:10.21037/gs-21-470

Intraglandular dissemination is a risk factor for lymph node metastasis in papillary thyroid carcinoma: a propensity score matching analysis

Gland Surg. 2021 Dec;10(12):3169-3180. doi: 10.21037/gs-21-470.

Authors

Bei Qian^#¹, Shuang Guo^#², Jun Zhou¹, Xincai Qu¹, Shoupeng Zhang¹

Affiliations

¹ Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

^# Contributed equally.

Abstract

Background: Intraglandular dissemination is one of the metastatic pathways of papillary thyroid carcinoma (PTC). However, few studies have assessed the impact of intraglandular dissemination among patients with PTC. The purpose of this study was to investigate the potential correlation between intraglandular dissemination and various clinicopathological parameters in PTC patients.

Methods: We retrospectively collected the data of 1,043 consecutive PTC patients in Wuhan Union Hospital from 1 June 2020 to 1 May 2021. The patients were divided into 2 groups according to the presence or absence of intraglandular dissemination. A propensity score matching (PSM) analysis with a matching ratio of 1:2 and a caliper value of 0.05 was used to compare the clinicopathological differences between groups. Logistic regression analysis was performed to quantify the association between intraglandular dissemination and cervical lymph node (LN) metastasis.

Results: In total, 117 and 204 PTC patients with and without intraglandular dissemination, respectively, were successfully matched. The LN metastasis rate of PTC patients with intraglandular dissemination (88%) was significantly higher than that of patients without intraglandular dissemination (67.2%; P<0.001). The number of metastatic LNs in patients with and without intraglandular dissemination also varied greatly, at 9.62 (SD =7.92) and 3.33 (SD =4.23), respectively. Intraglandular dissemination was associated with an increased risk of LN metastasis in both the unmatched patients [odds ratio (OR), 3.19; 95% confidence interval (CI): 1.74 to 5.86; P<0.001] and the matched subset (OR, 4.00; 95% CI: 1.98 to 8.05; P<0.001). No statistically significant differences were found in age, gender, tumor size, histological subtypes, extrathyroidal extension, or presence of Hashimoto's thyroiditis (HT) (all P values >0.05).

Conclusions: Intraglandular dissemination is a risk factor for LN metastasis in PTC, which suggests a need for more thorough LN dissection and closer follow-up in these patients. This finding may provide reliable reference data for the risk stratification of patients with PTC.

Keywords: Papillary thyroid carcinoma (PTC); intraglandular dissemination; lymph node metastasis (LN metastasis); propensity score matching (PSM); risk factor.