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Review
. 2015 Oct 2;10(10):e0139021.
doi: 10.1371/journal.pone.0139021. eCollection 2015.

Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Wei Sun  1 , Xiabin Lan  1 , Hao Zhang  1 , Wenwu Dong  1 , Zhihong Wang  1 , Liang He  1 , Ting Zhang  1 , Siming Liu  1
Affiliations
Review

Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Wei Sun et al. PLoS One. .

Abstract

Background: Central lymph node metastasis (CLNM) is common in papillary thyroid carcinoma (PTC). Prophylactic central lymph node dissection (PCLND) for patients with clinically negative central compartment lymph nodes (CN0) remains controversial. The phrase "clinically negative" is used to indicate that patients exhibited no clinical evidence of CLNM by ultrasonography (US) or computerized tomography (CT) preoperatively. In this study, we analyze the risk factors for CLNM in CN0 patients.

Methods: The PUBMED and SCIE databases were systematically searched for works published through January 31, 2015. All of the patients included in this study underwent thyroidectomy+PCLND. Revman 5.3 software was used to analyze the data.

Results: Twenty studies and 9084 patients were included in this meta-analysis. The following variables were associated with an increased risk of CLNM in CN0 patients: age < 45 years (OR = 1.59, 95% CI = 1.42-1.78, p<0.00001), male sex (OR = 1.95, 95% CI = 1.63-2.32, p<0.00001), multifocality (OR = 1.43, 95% CI = 1.22-1.67, p<0.00001), tumor size > 2 cm for PTC patients (OR = 2.98, 95% CI 2.08-4.28, p<0.00001) or tumor size > 0.5 cm for papillary thyroid microcarcinoma (PTMC) patients (OR = 2.30, 95% CI = 1.71-3.09, p<0.00001), location of the primary tumor in the central area and low pole (OR = 1.86, 95% CI = 1.48-2.33, p<0.00001), lymphovascular invasion (OR = 4.35, 95% CI = 2.24-8.46, p<0.0001), extrathyroidal extension (OR = 2.27, 95% CI = 1.76-2.94, p<0.00001), and capsular invasion (OR = 1.72, 95% CI = 1.39-2.41, p<0.00001). PTC (tumor size > 1 cm) exhibited a higher risk factor associated with CLNM than PTMC (tumor size < 1 cm) (OR = 2.83, 95% CI = 2.15-3.72, p<0.00001). Bilateral tumors (OR = 1.21, 95% CI = 0.92-1.58, p = 0.17) and lymphocytic thyroiditis (OR = 0.88, 95% CI = 0.71-1.09, p = 0.25) had no association with CLNM in CN0 patients.

Conclusions: Our systematic review identified several clinical features associated with CLNM in CN0 patients, including age, sex, multifocality, size, location, lymphovascular invasion, capsular invasion, and extrathyroidal extension. These factors should guide the application of PCLND in CN0 patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the study selection process.
Fig 2
Fig 2. Forest plots of the association between age and CLNM in CN0 patients.
Fig 3
Fig 3. Forest plots of the association between sex and CLNM in CN0 patients.
Fig 4
Fig 4. Forest plots of the association between multifocality and CLNM in CN0 patients.
Fig 5
Fig 5. Forest plots of the association between size (PTC) and CLNM in CN0 patients.
Fig 6
Fig 6. Forest plots of the association between size (PTMC) and CLNM in CN0 patients.
Fig 7
Fig 7. Forest plots of the different prevalence of CLNM between PTC (tumor size>1cm) and PTMC (tumor size<1cm) in CN0 patients.
Fig 8
Fig 8. Forest plots of the association between location and CLNM in CN0 patients.
Fig 9
Fig 9. Forest plots of the association between lymphovascular invasion and CLNM in CN0 patients.
Fig 10
Fig 10. Forest plots of the association between capsular invasion and CLNM in CN0 patients.
Fig 11
Fig 11. Forest plots of the association between extrathyroidal extension and CLNM in CN0 patients.
Fig 12
Fig 12. Forest plots of the association between bilateral tumors and CLNM in CN0 patients.
Fig 13
Fig 13. Forest plots of the association between Hashimoto’s thyroiditis and CLNM in CN0 patients.
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Grants and funding

This work was supported by Liaoning BaiQianWan Talents Program (No. 2014921033), URLs: www.ln.hrss.gov.cn/ln/99/10/2014/11/i45652.shtml.