Gland surgery · 2025
Metastasis number and ratio in regional lymph nodes as predictive indicators for distant metastasis in medullary thyroid cancer: beyond American Joint Committee on Cancer nodal staging.
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Chen Zihan, Su Jiesheng, Li Naishi, Xia Weibo
Аннотация
BACKGROUND: It has been reported that medullary thyroid cancer (MTC) with distant metastasis may result in poor prognosis. The aim of the study was to estimate the risk of distant metastasis in patients with MTC based on metastasis number and ratio of regional lymph nodes, more than just according to the 8th edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system.
METHODS: This cross-sectional study involved 744 participants from the Surveillance Epidemiology and End Results (SEER) STAT 8.4.3 database from 2018 to 2022. Multivariate logistic regression was performed to determine the predictive value of the condition of positive regional lymph nodes for identifying distant metastasis. The estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: In patients with MTC, the 8th edition of the AJCC node (N) stage could traditionally predict the risk of distant metastasis, with N1a (OR 6.21; 95% CI: 1.46-42.42; P=0.03), and N1b (OR 23.20; 95% CI: 6.69-146.54; P<0.001), compared with the stage of N0. However, the upward trend was relatively more significant in the model with the number of metastatic regional lymph nodes. The number of positive regional lymph nodes could predict the risk of distant metastasis, with 1-10 (OR 9.13; 95% CI: 2.47-59.11; P=0.004), 11-20 (OR 25.72; 95% CI: 6.52-171.29; P<0.001), and >20 (OR 26.44; 95% CI: 6.50-178.95; P<0.001) metastatic regional lymph nodes, compared with no metastasis of regional lymph nodes. Similar results could be found in predicting bone metastasis. The cut-off value of metastatic regional lymph node ratio metastatic regional lymph nodes in predicting distant metastasis was 0.176. Patients with the ratio greater than cut-off value were found to have a significantly higher risk of developing distant metastasis (OR 18.24; 95% CI: 6.33-77.26; P<0.001).
CONCLUSIONS: Metastasis number and ratio of regional lymph nodes can be effective predictors for distant metastasis in patients with MTC, which is helpful for the modification of the 8th edition of the AJCC N stage.
METHODS: This cross-sectional study involved 744 participants from the Surveillance Epidemiology and End Results (SEER) STAT 8.4.3 database from 2018 to 2022. Multivariate logistic regression was performed to determine the predictive value of the condition of positive regional lymph nodes for identifying distant metastasis. The estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: In patients with MTC, the 8th edition of the AJCC node (N) stage could traditionally predict the risk of distant metastasis, with N1a (OR 6.21; 95% CI: 1.46-42.42; P=0.03), and N1b (OR 23.20; 95% CI: 6.69-146.54; P<0.001), compared with the stage of N0. However, the upward trend was relatively more significant in the model with the number of metastatic regional lymph nodes. The number of positive regional lymph nodes could predict the risk of distant metastasis, with 1-10 (OR 9.13; 95% CI: 2.47-59.11; P=0.004), 11-20 (OR 25.72; 95% CI: 6.52-171.29; P<0.001), and >20 (OR 26.44; 95% CI: 6.50-178.95; P<0.001) metastatic regional lymph nodes, compared with no metastasis of regional lymph nodes. Similar results could be found in predicting bone metastasis. The cut-off value of metastatic regional lymph node ratio metastatic regional lymph nodes in predicting distant metastasis was 0.176. Patients with the ratio greater than cut-off value were found to have a significantly higher risk of developing distant metastasis (OR 18.24; 95% CI: 6.33-77.26; P<0.001).
CONCLUSIONS: Metastasis number and ratio of regional lymph nodes can be effective predictors for distant metastasis in patients with MTC, which is helpful for the modification of the 8th edition of the AJCC N stage.