Meta-analysis Of The Prediction Of Lateral Lymph Node Metastasis In Papillary Thyroid Carcinoma With Central Lymph Node Metastasis

OBJECTIVE: Cervical lymph node Metastasis(LNM)often occurs in papillary thyroid carcinoma(PTC).A large body of evidence suggests that LNM has a negative impact on the patient's survival rate,which is mainly related to higher local recurrence rate and distant Metastasis rate.Because LNM mainly occurs in the central region of the neck,many current guidelines recommend central lymph node dissection(CLND)for patients with PTC rather than lateral neck dissection(LLND).However,it is worth noting that the occurrence of lateral neck lymph node Metastasis(LLNM)will have a greater negative impact on patients.The LNM of the thyroid usually migrates first to the central region and then to the lateral neck region.Based on the transfer pattern of LNM,scholars at home and abroad have conducted extensive research to find out the potential link between central lymph node Metastasis(CLNM)and LLNM.However,so far,the existing studies have not reached a consensus on whether CLNM can serve as a reliable predictor of LLNM.In order to further study and investigate the predictive value of CLNM on LLNM,this paper conducted a Meta-analysis on the basis of a systematic review of published research results in order to provide a relatively scientific reference for the treatment of cervical lymph nodes in PTC patients.METHODS: Computer searches of foreign databases such as PubMed,EMBASE,Cochrane Library,Medline,and Web of Science were conducted.The search time was limited from January 2003 to November 22,2017.Languages were limited to English.This study collected studies that included both CLN-positive,CLN-negative,LLNpositive,and LLN-negative cases.From the included studies,two investigators performed independent quality scores and extracted relevant data,and finally passed STATA 14.0 random effects.The model's combined odds ratio(OR)and 95% confidence interval(95% CI)were used to quantify the risk of developing LLNM in PTC patients with CLNM.RESULTS: After screening 1,304 articles published between January 2003 and November 22,2017,29 articles that met the criteria were eventually included,including a total of 14,270 patients.In the 29 studies included in the analysis,CLND was included in the included patients,and only 9 studies were performed on LLND in the included patients.The remaining 20 studies only treated patients with LLNM who were identified or suspected to have LLNM.Sex or prophylactic LLND.Meta-analysis showed that there was moderate heterogeneity(I2=49.0%,P=0.002)between the studies.The risk of LLNM in the CLN-positive group was significantly higher than that in the CLN-negative group(OR=8.16,95%).CI: 6.61-10.08).Subgroup analysis showed that studies with a primary diagnosis of PTC,preoperative clinical lymph node status of non-cNO,studies designed as prospective studies,may be the main source of heterogeneity for this Meta-analysis,but the combined OR The 95% CI was 3.69(3.23-4.22),4.21(3.79-4.66),and 4.75(2.62-8.64),respectively,which did not affect the foregoing results.Sensitivity analysis showed that the studies of Zhu YZ and Zhu LH et al.may be the source of moderate heterogeneity.Excluding these two studies,I2 decreased to 27.3%,combined OR=7.27,95% CI: 6.06-8.71 It is still consistent with the above results,indicating the reliability of the results.Using the Begg funnel plot and the Egger linear regression experiment to publish publication bias test,the results showed that P=0.002,indicating the existence of publication bias.CONCLUSIONS: The probability of CLNM in PTC patients is high,and this Meta-analysis demonstrates that CLNM can be a reliable predictor of LLNM in PTC patients,reminding us to pay extra attention to the side-neck region when treating PTC patients.Whether preoperatively or intraoperatively,patients with pathologically proven CLNM should combine other risk factors for prophylactic LLND.If patients have not undergone lateral neck dissection,they should be given more careful examination during follow-up,even It is a special treatment.In addition,we also need more prospective studies or more multi-center studies to verify the relationship between the two,at the same time,how to reasonably manage patients with high risk of LLNM also needs further in-depth research and discussion.